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1989, 01-04 Permit App: 89000021 Repair Fire DamageINF&MATION WORKSHEET PARCEL NUMBER: /65-1/ STREET ADDRESS: CITY/STATE/ZIP: SUBDIVISION: BLOCK: LOT: ZONE: DISTRICT: LOT AREA: F/A: WIDTH: DEPTH: R/W: OF BUILDINGS: / @ OF DWELLINGS: / WATER DISTRICT: OWNER: Or, 7/0,77 o s lam//ei: ' / - PHONE: - - MAILING ADDRESS: // "tide) CITY/STATE/ZIP CONTACT: PHONE: fr SETBACKS:.- FRONT: .LEFT: RIGHT: REAR: PERMIT USE: /fe S/ rea /d i'I — /1---i /e v "nee e__ BUILDING INFORMATION— ,.:9-0000:-,.; CONTRACTOR LICENSE:NUMBER: .A/o/ - CONTRACTOR: Or p(/-7-�L PSUnsA,/i c(✓/ __._PHONE: -yOE/- MAILING -ADDRESS: (! �. ��jC /� (�%'jyp ARCHITECT/ENGINEER: `-"PHONE: - - MAILING ADDRESS: NEW: REMODEL: ADDITION: CHANGE OF USE: DWELL UNITS:' OCCUPANT LOAD: BUILDING HGT: STORIES: BUILDING DIMENSIONS: REQUIRED PARKING: X (WIDTH X DEPTH) SQ. FT.: @ HANDICAP: SEWER (Y/N): HYDRANT: Revised 1/38 PLUMBING INFORMATION CONTRACTOR LIC#: CONTRACTOR: MAILING ADDRESS: *************************************************************************** CONTRACTOR LIC#: CONTRACTOR: MECHANICAL INFORMATION MAILING ADDRESS: ELECTRIC: GAS: OIL: CCAL: WOOD: SOLAR: HEAT PUMP ENERGY CODE: WSEC: NWEC: UTILITY: SGC: APPROACH: - PRESCRIPTIVE: - POINT:--- - - COMPONENT: - SYSTEMS: *************************************************************************** PLUMBING FEES ITEM -DESCRIPTION - PROCESSING FEE DUCTWORK.SYSTEM- WOODSTOVE/INSERT . GAS-WATER._gEAIER -. GAS HTG EQUIP(100,000.)BTU GAS HTG EQUIP +100,000 GAS PIPING -.# OF UNITS HEATPUMP.1-100 BTU HEATPUMP--101-500-BTU ----- HEATPUMP 501-1000 BTU HEATPUMP-1001-1750-BTU HEATPUMP +1751 BTU REFRIG-1-100 BTU _-... _ .. ..-.. REFRIG 101-500 BTU REFRIG--501-100 BTU--- - REFRIG 101-1750 BTU REFRIG.+1750 BTU- - AIR CONDITIONER 0-3 HP AIR CONDITIONER 3-15 HP AIR CONDITIONER 15-30 HP AIR -CONDITIONER 30-50 HP AIR CONDITIONER +50 HP VENTILATING FANS EVAPORATIVE COOLERS HOODS CLOTHES DRYER RANGE GAS LOG UNLISTED GAS APPLIANCE AIR HANDLER 1-10000 CFM AIR HANDLER 10000 CFM NUMBER OF- ..,__ ._._ -_- ITEM DESCRIPTION . -........-NUMBER OF YES OR NO PROCESSING FEE _,-YES OR NO -TOILETS SINKS SHOWERS KITCHEN SINKS :DISHWASHERS GARBAGE,_DISPOSALf...y CLOTHES -WASHER UTILITY SINKS _-:ELECTRIC WATER HEATERS` FLOOR DRAINS --------FLOOR SINKS .-_., BAR SINKS ROOF DRAINS LAWN SPRINKLER SEWAGE EJECTOR WATER SOFTENER URINAL DRINKING FOUNTAIN