1992, 01-27 Permit App: 92000461 Mechanical Fixturesmtbnk+nIIew*. ra tai+uh MrrUbMlIu® runm
3'.inormation Worksheet
JOB STREET ADDRESS: l3 k O.cl _ C
CITY/STATE/ZIP: �_ X . ,S PARCEL NUMBER:
OWNER: hvt PHONE NUMBER:,
•
MAILING ADDRESS: - o-ot 9
(Street)
CONTRACTOR: hrMS C
(City/State)
vU �
(Zip)
LICENSE NUMBER: g -Atm ie -s4-4 ( o
PHONE NUMBER:
MAILING ADDRESS: =11 Sr 1 L. i s -S2-4 jab � , , �.� L:a./►ers d& -
(Street) (cit state) (Zip)95,2404
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
=AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
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
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.'0 =
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 =
to994
l'Le_
NOTE:
SIGNATURE
IMUM PERMIT FE ShIS $35.00
SUBTOTAL
$ e -
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 1-ck
Sookane Cn»m*' nnnartment of Building and cafety