1993, 05-12 Permit App: 93003455 Mechanical Fixturesq3-5/55 5- co9`3
393s
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet blg11b
JOB STREET ADDRESS: S • 1 too S 111/4-C�h NNvv
CITY/STATE/ZIP:SPOt -Jff- Wm} 9924 Z PARCEL NUMBER:.
OWNER: ,C14-It*6. (l-) 14G S PHONE NUMBER:
MAILING ADDRESS: AL -
(Street) (City/State) (Zip)
CONTRACTOR:bt VCO y C.tt4 t,WL- LICENSE NUMBER:D 1 VCO EC 108 I -C -
PHONE NUMBER:
MAILING ADDRESS: fJ • 1 15 M AOI- ► A SPbK> 1. 9
(Street) (City/State) (ZIP)
MECHANICAL WORK
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
SAS EQnMEN <1(3G UQ u
GAS EQUIPMENT+100,000 BTU
iGM p1(?111G`„{EPPI S
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
p1L1*F tR Ft IG 1 3w # 01
BOILER/REFRIG +1,750M BTU
• HEAT PUMP & AIR CONDITIONER 3-15 TONS
€I MF4T,�p4l1M. f 0 DI;ONE S
• HEAT PUMP & AIR CONDITIONER 30-50 TONS
N AT f of FSB of 0t 1T13t g: , 0
VENTILATING FANS
t> YAP: ,FtA ' me Wag47
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
DANOners. ,
GAS LOG
legg trl aus tr�aarrAP:
UNLISTED GAS APPLIANCE <400,000 BTU
El p GASFArrP ANCB O RTOI i1
USED APPLIANCE <400,000 BTU
;USED Apl510:011:491 itin xk
AIR HANDLER <10,000 CFM
AIa,HANU gilt 110,000 FME
NOTE:. MINIMUM PERMIT FEE IS $35.00
SIGNATURE 6.^.1
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
x 25.00 =
i
x10.00 =
10
x 12.00 =
12-
x 15.00 =
Z
x1.00 =
, • 2-
x 12.00 =
x
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x12.00 =
x 20.00 =
x25.00=
x 35.00 =
x 60.00 =
x 10.00 =
x10.00 =
x 50.00 =
x10.00 =
x10.00 =
x10.00 =
x 10.00 =
x10.00 =
It
x50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x15.00 =
SUBTOTAL
$ 2.4
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
co
_ $ 49
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