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1991, 09-18 Permit App: 91006055 Wood StoveMECHANICAL PERMIT APPLICATION FORM ' Information Worksheet G S C•� 'i�► _ (� JOB STREET ADDRSS: A2 ) .I 5, / /� 6. CITY/STAT IP: ��Ju Q1LX_ ) 60 99837 PARCEL NUMBER: SSL S- v. OWNER: ,t (L' Ct 6 L1 PHONE NUMBER: 9,202- .36 OD MAILING ADDRESS: (5 OlAnc e (Street) (City/State) (Zip) CONTRACTOR: rr} I CA G4't2DE,iJ Cf JJFr2 LICENSE NUMBER: AICD &C I -73 bt. PHONE NUMBER: (SO9) Ra(o- ' / MAILING ADDRESS: e • q3 D .5.p 2A91,( e, S.opKAi,.l e_ LOA 99 2 0& (Street) MECHANICAL WOR DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) ��t/� y���■rly�' t{ }`(}`� .:}::'f.?ifiiR??+f} �:i4C...::-}}}i:::�::i�•: i}}}::::y??tiv. }iJ: w•Y:[::-.:nLN.r::::::Kv�lici?i_Xi���•iivk:Yiirir:i i:i iiY.i4jhS% GAS WATER HEATER . ' -.„ N' nsxi-:x.}:i-:ru.A: r. GAS EQUIPMENT +100,000 BTU DUCTWORK) v`>f:e:::w4..•o-it}?vi:"}}ii':`.%:h.�.�..-...�.?..: x:. -::.n --}t..'. x:•.w.•.vwrainws:-.vn-n:x.•..::.v ;Gq. •.ivvci.;nv::vi}v' ':3 �:c:%4}>:y '- ;,v }yni:-ruL;r:4:asiv.:o'a4vv: BOILER/REFRIG 1-100M BTU r'.v�{�^vOvp�^^v^ww!nny^N :..:x•,•y%S.}...u;?p.-:wcvl+;iyrwnwucavanF.O,.:'p::F.} - :'- .• bi.A�b.:YYb:}:::.'f.-' 'M :. a:..n�:.x:.-:.s-n..�..d:w,�. .. ..... •. a�ww,:ao- aw;Fdf.::i:::P.was:"3biR::=;k:;::i:3S§r:.-:�;::is:;;�c.:�:�:Y: BOILER/REFRIG 501-1,000M BTU . ''-=- ==: .,,ter?:,:�m,.�.{{, `■:.:�.�:,.-??:??:??.?.H:.. ,-,y�.<.,..-.Y::....�?� .... ..:�. .�:?i. 3110 i ril j okalF wAG' tf.v.:nwq W6]bw•Op'fi`•f-0uj` '- Y• •d:•:}}.x•''•:n9i BOILER/REFRIG_+1,750M ' ° `* '.Mi v'.- ....iVV .•(1-. :: ND : :< NES::fit-�:� : y��j5�.:."-:>.:..:�.: ''-b:r�'�b3Avv�i6:Ymin•'nrtiv::: nviv:.vA•bG.aw.:�vvi F�rtins�..00fhJw+�Lvva&iitii.6Yr":.arvi-'A'Giii.: HEAT PUMP & AIR CONDITIONER 3-15 TONS: ISKa:w�rww.•nv.��wj.+{m�wnwnrpy.; n"yX4¢ypf' r HEAT PUMP &AIR CONDITIONER 30L50 TONS' .„,,�,�..*M�/.�.' :,.,,�,.::�},,�<v '(My rte+ :!�.{ � '�:': id.,„*. ,oto-.,,:",,,rw73i4TEArlOAN..S .SW ?'a7k� "l%V +7.. '�..�'• a: VENTILATING FANS °°_.;• .•.� ,:. , M.:,�. max.,., .�. 74 x }.wxdoa..�a.a:�Fc3� ��.ww.,,�rv,�.,...,.� -i'kc�x: Vzir,Yt�`•A?'«iawo7cs::e. TYPE! HOOD (PER 12' OR 12' PTN. OF HOOD)'°, :v; .wt..-..�.�...-:..+,5,'y`tfSRL>.•::xX?�F'u:•,>.l.',N.•-:;rfi : .�:.. �: �!L+}�.>`2%vsr}}v->g.._rb: ':iii.. {7.t/.V I +.•Lw.'F ; : �ivi.� aY-..'X. `t''•v3y: }L.:' .} ..:}:: } ?S<? `? c..,..�:.i:&-:: i.:i.,.:c :ccaU�:�so-}i�:R'a- ..•::!s.c.'�,..:;,✓-�.:ix.:�w`awl=:.%�::i}`<iS�C+ic:-i<:..._xn... C LOTHES DR YER GAS LOG 4Mi iJ:f h• 4ti lk UNLISTED GAS APPLIANCE <400,000 BTU .ULINSTED:;GAS AF PLiA CE 00 B 11, USED APPLIANCE <400,000 BTU :......................................................... .. USED SAP.PL IANCE >400 000 BT >> < > > > < > AIR HANDLER <10,000 CFM AI5;HANDLER:>1O,000;CFM v•kl. NOTE MINIMUM PERMIT FEE IS $35.00 SIGNATURE (City/State) (Tp) NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x 25.00 = X 10.00 = x12.00 x 15.00 '`=. .-< x 1.00 - 'k x 12.00 -�: x 20.00 x25.00 `= x 35.00. = : ; x 60.00 "_ >:�,> Y x 12.00-= .:i x 20.00 ; fi x 25.00:= x 35.00 =., x 60.00 .t=, x 10.00-- x 10.00 -= x 50.00"= .,u x 10.00==a;° x10.00 =. x 10.00 = x10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = _ , 41 a e - > . _ . i-.:.: _ W =, .: r .:: _ :., •r.. _:.-�`.:,. .•...,•:;,:,,,-4',,,‘.4-- • :.,y- :. >.: r. 1: � I i.--;=!-3�: i 7.="Y' . ' ,�} . ... _ a : . , . _ . N -t _. • . _ : -. • SUBTOTAL $ 0..6 00 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ .rsOo '^ of Buildings - ..Holm r�nr .�„