1989, 11-02 Permit App: 89004423 Furnace, PipingJOB STREET ADDRESS:
CITY/STATE/ZIP:
GONER:
MAILING ADDRESS:
r p
commsammu {r r
NAILING `1 88Ss
MECHANICAL PERMIT APPLICATION FORM
•
Inforpati,on Worksheet
kN.rJ\-- PARCEL NUMBER:
PRONE NUMBER:
Qom/
(City/State) (Zip)
v LICENSE NUMBER: 403 e -r /174-(i0
PHONE NUMBER: 92:'1_. - i..7
eekt)
(City/S
,`MECHANICAL WORKSHEET/FEE SGiEDULE
DZCRIPION
DUCTWORK SYSTEM_
WOODSTOVE/INSERT , i..:,
GAS WATER HEATER
NUMBER X EACH
OF UNITS UNIT
(Zip)
=AMOUNT
HEATING EQUIPMENT <1#0, 000 BTU
HEATING EQUIPMENT +,000 BTU
GAS PIPING (5 OR ` MORE. }SACH : )
REFRIG 1-100M BTU A/C OR HEAT PUMP)
REFRIG 101-500M
REFRIG .501-1, 000M
REFRIG 1,001-1,750M STU
REFRIG +1,750M BTU
HEAT PUMP & AIR . . . » . 0-3 TONS
REAT PUMP & AIR wAb< ,, ate• 3-15 IONS
HEAT PUMP & AIR 15-30 `'TONS
NEAT Anna tr` A/R ?-50 ,STENS;
PAW it AIR Q-43001 TZ
'ANS••.e;•
2' PTN.,OF HOOD)
1'1100
+CtOT ES ''DRYER .�
:�1cs .a+. «,rr. .,;'Y.'ri. , .,�- 'r'E R'- a4� +�••. .••. �k:
SO4,bass LYS ('NOT -* 0 ELSE ERE) _
"ONLTSTED GAS APPLIANOI 400,000 BTU
NLTSTED GAS APPLIANCE >400,000 BTU
USED ,APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR VAit" 41434,*
.e,
x$10.00 =
x 25.00 =
x 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;:5.00 =
x '60.00 =
X 10.00 =
x 10.00 =
x 50.00 =
x 10.00 i
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 =
NOTE: MINIMUM PERMIT FEE I8 $35.00
SIGNATURE
SUBTOTAL
$ 1,`"•-•)
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
9. r .
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