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1992, 12-01 Permit App: 92010520 Mechanical
�JOBTREET ADDRESS: Mtt;nANIUAL rLUM11 ArrutiAlIUM rUHM Information Worksheet 1 CITY/STATE/ZIP: PARCEL NUMBER: t15iz 3 11 1 OWNER: �'�, P PHONE (NUMBER: . �ZG MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: c LICENSE NUMBER: R PHONE NUMBER: R -L -L - 5-b c, - MAILING MAILING ADDRESS : r2 1\ g lc. VIX Arra S 4 t1¢ (Street) (Ci y/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION -0F UNITS UNIT =AMOUNT DUCTWORK SYSTEM_ _ _ _ _ _ _ _ _'_ _ WOODSTOVE/INSERT _ _ _ _ _ _ _ _ _ - _ _ GAS WATER HEATER_ _ _ _ _ _ _ _ _ _ _ _ HEATING EQUIPMENT <100,000 BTU _ _ _ _ _ HEATING EQUIPMENT +100,000 BTU _ _ _ _ _ GAS PIPING (1 - 4 OUTLETS) _ _ _ _ _°_ _ GAS PIEING (5 OR MORE. EACH:)_ _ _ _ _ _ REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)_ REFRIG 101-500M BTU_ _ _ _ _ _ _ _ _ _ BT REFRIG 501-1,000M U_ _ _ _ _ _ _ _ _ _ REFRIG 1,001-1,750M BTU_ _ _ _ _ _ _ _ _ REFRIG +1,750M BTU _ _ _ _ _ _ _ _ HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ HEAT PUMP & AIR CONDITIONER 3-15._TONS _ HEAT PUMP & AIR CONDITIONER 15-30 TONS _ HEAT PUMP & AIR CONDITIONER 30-50 TONS _ HEAT PUMP & AIR CONDITIONER +50 TONS _ _ VENTILATING FANS _ _ _ _ _ _ _ _ _ _ _ EVAPORATIVE COOLERS_ _ _ _ _ _ _ _ _ _ TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD1 TYPE II HOOD_____________ CLOTHES DRYER _ _ _ _ _ _ _ RANGE__ ___ -_-_-_-_-_-------- GAS LOG _ MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ UNLISTED GAS APPLIANCE <400,000 BTU _ _ UNLISTED GAS APPLIANCE >400,000 BTU_ _ _ USED APPLIANCE <400,000 BTU_ _ _ _ _ _ _ USED APPLIANCE >400,000 BTU_ _ _ _ _ _ _ <10,000 CFM AIR HANDLER_ _ _ - _ _ _ _ AIR HANDLER >10,000.CFM _ _ _ _ _ _ _ _ x$10.00 = x 25.00 = 10.00- = x 12.00 = x 15.00 = x 4.00 = x 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00-= x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = Lx ( c`�-'� l `Z _ _ _ _ _ _ _ _ SUBTOTAL I $ '2-4 -'ctk, PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT NOTE: XINTXUM PERMIT FEE IS $35.00 FEE DUE _ $ � SIGNATURE Sookane Countv Department d Building.and _Safety_ ____