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1992, 10-08 Permit App: 92008620 Mechanical Fixtures
llkr-H- Ar c MECHANICAL PERMIT•APPtICATION FORM 113 Information Worksheet JOB STREET ADDRESS: F �� I ea'` DS ‘rt --4, VEFAbittrc urs LI CITY/STATE/ZIP: C/401&‘.12 WA-- ci'9adc, PARCEL NUMBER: '/J /4 2 3/f// OWNER: l " \A eisl c S ''E L e5i-eo n0•('c' PHONE NUMBER: 9ai-5"9.7/ MAILING ADDRESS: `°Thfa.- ' (Street) (City/State) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Zip) (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WQOSTQNE/INS,K,; GAS WATER HEATER IGA& PQUIpM NT iV,U0t3 PU ING 1P GAS EQUIPMENT+100,000 BTU DUCTWORK) {1S PIPINCa (A",t;1TM� a?