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1992, 05-19 Permit App: 92003549 Gas Log PipingLl 5 _5 S(4 u, e-, -.��C�HANICAL PE��MIT APPLICATION FORM II Informatio n Worksheet JOB STREET ADDRESS: CexA+elf?_- CITY/STATEIZIP: SnDK-- Loa PARCEL NUMBER: OWNER: V^n jY__Q_ 4f)Qeh PHONE NUMBER: - MAILING ADDRESS: (Street). (City/Stated - (zip) CONTRACTOR: -F-pr) crGgef)E)j CEtjfFy? LICENSE NUMBER: F41C.0 &C- 1-7.3 bL4 PHONE NUMBER:�S -q -,? Dq) X., c111 MAILING ADDRESS:. E (13)(2 -Spefc1que- jgD)�AAJ (Street). (City/State) (zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRICIDUCTWORK (SEPARATE SYSTEMS) x 10.00 V 00 . . .. DSTO: 651 -IN -SE 2. . ..... x 25.00 r GAS WATER HcATER`­ x 10.0.0 .... ...... . . . . . ...... x 1200 V - GAS EQUIPMENT4100,000 BTU DUCTWORKI_;�­ x 15.00 HEAT PUMP &AIR CONDITIONER 3(),-50TONg-_- �0 ...... ......... . ......... x 10.00 ............ .. . . . . . . . . ------- - ---- --- -- - •ff-aT, I Ou BOILERIREFRIG 1-100M BTU _ -0- BOILERIREFRIG 501-1,000M BTU;. ..... t BOILERIREFRIG *11,750M STU;,,4; HEAT PUMP. &:AIR CONDITIONER 3-115TONS_ x 1200 x 20.00 x 25.00 x 35 00. . x 60 00 x 20.06 X 25.0 10.00 Go NEO`t_. ( i!:�� . . ................. ................ . .. .. .... ...... ................... 4� UNLISTED GAS APPLIANCE <400,000 BTU ..... HEAT PUMP &AIR CONDITIONER 3(),-50TONg-_- 35.0D.7;-::-"' x 60.007�� 10.0D 50 x .00 x 10.00 in nn x 10.00 ............ .. . . . . . . . . ------- - ---- --- -- - •ff-aT, I Ou VENTILATING FANS. X�, A Gx TYPE I HOOD (PER 12' OR 12'PTN. OF HOOD)'..-.—. Ty CLOTHES DRYER 10.00 Go NEO`t_. ( i!:�� . . ................. ................ . .. .. .... ...... ................... ........... x 10.00 GAS LOG .10.00 10.00 Go NEO`t_. ( i!:�� . . ................. ................ . .. .. .... ...... ................... x 10.00 - UNLISTED GAS APPLIANCE <400,000 BTU ..... x 50.00 ............ GAS �APP 00.000z, ....... .... ...................... . ... . ....... ...... ......... X100.00 USED APPLIANCE <400,000 BTU x 50.00 .. ............. ... .. ........... ................ :.USE0:APP0ANCln,_ ........... �,Goo . . . ........... ........................... ....... ............... X100.00 AIR HANDLER <10,OOOCFM x 12.00 . .. .......... ............. AIR CANDLER ................. .... ...... ..... . . .. ..... ...... ...... x 15.00 NOTE-' MINIMUM PERMIT FEE IS S35.00- SIGNATURE ti-'JSUBTOTAL , s JPLUS: PROCESSING FEE +s 25.00 EQUALS: TOTAL PERMIT OD F =E D U E