1991, 10-23 Permit App: 91007124 Pellet StoveMECHA A ` w `,L PERMIT APPLICATION FORM
. Information Worksheet
JG STREET ADDRESS: "7„) 3 �-1 I t,
CITY/STATE/ZIP: .,(1.)K ra i c.. Kc X206 PARCEL NUMBER:
OWNER: C .Vnei-34 �� 5✓vi i 4 h PHONE NUMBER: �' c2(/ ` ?o y 3
MAILING ADDRESS: . Y v\o-
r (Street) (City/State) (Zip)
CONTRACTOR: r Pr) CX & 4eDE,iJ CES JJ E►2 LICENSE NUMBER: Vi4-ICO 6/C ! •73 b LA
PHONE NUMBER: (SCA) .2(.0-89 / l
MAILING ADDRESS: E. q31 b .5.to eA3ue_ LvP) 9920/0
(City/State) (Tp)
(Street)
.- MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE+S
•
GAS WATER HEATER '
GAS EQUIPMENT+100,000 BTU DUCTWORK)
em^'MrMvw,vM1vmyr.};rixxgvvr.}y. yr _}E?•."v}: v.:}!f: s �x.:nyvv }r.}}}}: ;.
t&
BOILER/REFRIG
BOILER/REFRIG .1-100M BTU
w•Ax: :ph�� F
FKs:vAt{
BOILER/REFRIG
501-1,000M BTU
N K.- M*ryywvw.r{mi2i.r-}Xf.-+JC'<v^^Y
BOILER/REFRIG +1,750M
HEAT PUMP & AIR CONDITIONER 3-15 TONS - -T
iii.:�,.,tiY,.,�.,,,,�•K,�.•:�r.,};r,.�:��r�K.t.:ryy;�:+.•.�..,...}yw�Ky,.,�..�.r.�,:��a�•o� }r .�su}:,,Y/1 .},�..:-
M'7iww.,,1 ;:..i,. ,,,,� o , .fuO , I...� w�a:}Q . v ?.
HEAT PUMP & AIR CONDITION_ER 30-50 TONS
VENTILATING FANS ---_. -
�OOxA00iht'1�Ow•wFxrvw:::x�iC - { ar {�{� •.. fY,ih}�,IY
TYPE 1 HOOD (PER 12' OR 12' 12 -TN. OF HOOD)
M-ilay..-../�,�{ ".'"""?F:!�:;:c}.:�•r::tt;;: /'»':T;:?:$iw:} : xx�<.,�.,..w•:xco�wy:;;is^-.'-; :• r
-
CLOTHES DRYER
e:- ,saw:,._,
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
UUNSTED GAS APPL[ANCE 400,00• BTU...
USED APPLIANCE <400,000 BTU
USED.APPUANGE,00A:Tfi
AIR HANDLER <10,000 CFM
`AIR}iANDLER>'1O
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
IAii—N..F 4:
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
1 x 25.00 =
x10.00=
x 12.00 =
x 15.00 .=
x 1.00 =
-
.y
, .• .: -6;3
x 12.00.
x20.00
x 25.00 =
x 35.00= Y. _
.
x60.00`
x12.00`,F
x 20.00 =
x 25.00..
x 35.00 =
x60.00-
x 10.00 ._'. -
x10 00
x50.00`
x 10.00
x10.00_.
x 10.00 =
x 10.00 =
ze ry
-: :
w w
` ` ,
'.'!' 1X%11!�ih�f.�K1"!..
F
.:
'ra .''-,::
;t.... .,..^! .f'. .-
-...
i' •
..t .'�: :x.-
p:
i 1 ..
'.'
i
;.
x10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL $ / 3
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT-,
FEE DUE _ $ i� �'.0 J
s on of Bui;d r -"
•