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1991, 12-16 Permit App: 91008643 Gas Log, PipingMECHANICAL PERMIT ;PLICATION FORM Informaticn Worksheet JOB STREET FESS:c. 3/163 *t.)3( -11V-) CITY/STATEJZIP:SijM tOCG a4V,0 PARCEL NUMBER: OWNER: UfyuJ1. ----e;frucAto, PHONE NUMBER: MAILING ADDRESS: 5 • B4C315)1-06, sthl vo,,,,k 9 ul ciq (Street) (City/ tate) _ - (Zip) CONTRACTOR: Ea ) C.J) G42DEki C.-EIJI-Fit?. LICENSE NUMBER: n4 -1C-0 &C., I 73 tL& PHONE NUMBER: 650q) q0?(' -"/I MAILING ADDRESS: E. 6)31 D 3peP5Lke_ (Street) (City/State) -.MECHANICAL WORKSHEET/FEE SCHEDULE 4)t1 992 olo (Zip) " -;• DESCRIPTION :"•-•-•-_=. • • ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) • - -4Entilitergiottalpap.I.,::,:i:. GAS WATER HEATER t 147arditifitift.7.7. GAS EQUIPMENT •100.0110 BTU DUCTWORK:-- 1:47•CrOTTCCifititartiat,,7ratt,:_r.P-AW'Migillikto BOILEFUREFRIG1-100M 4. jek-Ett,t,,,51 : BOILER/REFRIG 501-1.000M gir ' ; AtIrregal 0 BOILER/REFRIG +1;750M BTU IMMIEN•MgerOlirtr_...9,.._EIL.,1r47457613:2W"Igia HEAT:PLiMPI:& AIR CONDITIONER2;15 TONS*4V,0 1 : 0 EAT;pUMeBrAIR CONDMONER-30:50 TONST" tflCOND VENTILATING FANS rket4kkv VECOMERS: 444. nitxiMPr. k :TYPE! HOOD (PER 12" OR 12' PTN. OF HOOD) '-c:7`..'"f•;7.-- ;--*'47..gfiri-17150-75:53PMFEWMPRQ::$""*Trt* •••••,;i: CLOTHES -valegr__MATAW GAS LOG7:`,'-"•'7:7-: - 0§TottagtaftlflOted9ttittbILSEW14 UNUSTED GAS APPLIANCE <400,000 BTU USED APPLIANCE <400,000 BTU 1-isED'IsTsruAt4c,E,,S00 AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE SpokatiE.. - NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x 25.00 =- x10.00 = x 12.00 •'=: : x 15.00 = .' . - x100 =,, ,,.i., *1200 x200075--;:f...-fl ,x25.007;:i.--,;_ x3500=_:::. x 60.00.--', ' x 12.00--44-7-1. , .. ..=‘,.."-14;,- x 20.00 x 25.007=7' .-- x35007=: _ , -, --. --', ;•--4,-;. : . _ '• - - .'4-:---_,- ''''' ' - t'&.:.,,:',441e4. .-. '...',.., ':-.2 ."1 : :"...:. r'.":.,t 1«:..i -i',:,•:' ,A• i..- '30.•:".;:f2-11;:, --,'-'''' • "C-- .'"-V--"e " ---.:4'..1:::,,,z7--,4;.,.-. .1-7- :-. : --- • - „ ,•:. '„ .-,::::,%;4,-A-.4„,%-.4,4-_ ;---- - -- --, •••• ,t-- :e•-;,-,-_-..%4-...;,'1,:,' _ :.r...tif.,-,.:: - -fe;:t4t044,F]i'Atr.t.rtr47:-"- 'e.:4.ik,•-ri--••,i-..-‘-,,, .,-..-r• 4.-11A,iiPts..4,74.10.4z-z •-"'''-'"-:-t''f,-%N.Y1---, •,- .-'0'.--: ' -': -- q _ - x 60.00."'W--1-1,--:---n--.1.•=t:,tc",". x 10.004:;:'- x 10.00- =':...: x 50.00- L-'',, - X10.00 =.- X 10.00 = • X 10.00 = • X 10.00 = x10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = ". -7-. • - - ' ,7: •:-- -i .', • - - - -: •-.: -7 ,-,.: --.4-----77:-E- • --- -:•-• ,-.• - - --- , • -; • ---,- `, - - - I • / , (3-0 _ SUBTOTAL $ 1 1. (11) PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE 1 =s T3? „A -