Loading...
1992, 02-21 Permit App: 92000962 Woodstoveti -C ' CrsrMECR IT :-PLICATION FORMaLA ICS Ho -Lc Information Worksheet LTQ JOB STREET A •: E S. 1 0. 1.IL .t 1 ) CITY/STAT IP: ( l 9 92Z. - NUMBER: OWNER: ALA. T (/ (QQ(j-1;1K) PHONE NUMBER: 7 - 7S A273 MAILING ADDR S:S(.livA-2____- (Street) En- (City/State) CONTRACTOR: f A)fO GK12DFiJ C-ENtFie LICENSE NUMBER: RA-ICA&C..I-73be( PHONE NUMBER: (7.5 -Oct) q.2(a-89 / MAILING ADDRESS: 6 • 613) D SoeA9ue, LJFI 992 Deo (Street) . _ .. MECHANICAL WORKSHEET/FEE SCHEDULE (City/State) (Zp) DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)'::.; VYOODSTQVE/INSERT GAS WATER HEATER _ 4 -:GAS,EQUIPMENT• c10(i,000 8T11(INCLUDE& ,... GAS EQUIPMENT+100,000 BTU DUCTWORK) -`1 GAS PIP..ING (,,,,FA DUTLET " ;: r ' , F:. BOILER/REFRIG.1-100M iG101400M13TU`,-.=s: "H BOILER/REFRIG501-1,000M:Bur 0 = - EFFIIG%0001= Th 0 M BTU BOILER/REFRIG+1,750M BTU:. -7t' (': It ilEA'taUMP'&AIR OONDITiONER O flONS: Vg WHEAT PUMP 8'AIR CONDmONER 3-15 TONS`4.-"ef•• HEAT PUMP VAIR CONDMONER 3040 TONS ' E CONDIR GONDMOh1E?+ 0 �M wL F VENTILATING FANS h POFf'ATIYETCOOLERS tAa _� YT ;:TYPE I HOOD (PER 12' -OR 12' PIN. OF HOOD),..? CLOTHES DRYER. ^; GAS MISCELLANEOUS OT COVERED ELSEWHERE; UNLISTED GAS. APPLIANCE<100.000BTU'• ULINSTED GAS APRUANCE>400,000 BTU: USED APPLIANCE <400,000 BTU USED APPLIANCE>400,000 BT(3 AIR HANDLER <10,000 CFM AIR HANDLER >10.000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE Sookan- Ma NUMBER :- . OF UNFTS ' x..,., XEACH UNIT ` - ... = AMOUNT x 10.00 = .... x25.00"=;. • AAA''' x 10.00 =: x12.00 =':.--- _ `x 15.00 . ' -: '. .. .. .. .1.1.00 t' a t .r; "".EF.�,. 1 . J — X 1200 _ w , , :-- is 20.00' 25 X .011 1::-11:14;t:- . Yirf'-- . x35.00. tr. n x 60.00 = ' ,. ' T... r; _. - .5 _ _._. x12.0 i-'. :;.>oFr y. v lvtil+ s/ - X 20.00' 1e- :4',� ' 4X;:- 'tfir:• '7,:-,.>-7- x 2.5.007-. ARti Ziii-0.st.t -1 k35:00:;";;-it....?.,t,:is:.: X60.00 , ,a. cr+ ?-.',7±.,:i, x10.0 0 .. _,.' X 10.00 .s. ::..... 14 x 50.00 r, - :_ ... x 10.00..,. .>... ;4- x10.00=', ., rt x10.00-,: ; x10.00= x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ ng.5, (k', PLUS: PROCESSING FEE +$ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ 60,o0