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1989, 11-02 Permit App: 89004457 Pellet InsertIIA F OF.MATI ON WORKSHEET -A CEL NUMI3ER: TREET ADDRESS: 2I TY/STATE/ZIP: (]�� �'ti4 � Qi 1 C 1(.i SUBDIVISION: BLOCK: LOT: ZONE: DISTRICT: I.OT AREA: F/A: WIDTH: DEPTH: R/W: OF BUILDINGS: € OF DWELLINGS: WATER DISTRICT: 3WNER: CNAN( �-A1— PHONE: - 4169% 'AILING ADDRESS: 'T'T'Y/STATE/ZIP: :ONTAC'T: :SETBACKS: - FRONT: LEFT: PHONE: RIGHT: I : EAR : WILA tttststttttt:tttttt:xxttttt:ttsxtst:ttttsxsttss I3LIT LDI NG I I:FORMAT ON ;):::'RAC:'1oR LICENSE NUMBER: ()lulu,C I'UR: s�� '1 cin9t��.��c�t�\Qti I'HONE: ` -CWc) - 1,1 LI NG 1..1)1)}.I::.5;: ?C:u1'J'EUT/ENGItt ER: a.I I.1 NG ADDRESS: NEW: REMODEL: ADDITION: CHANGE OF USE: rt -.LL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES: x HANDICAP: 'LSI L1)1 t:G lli MENS IONS : i±QUI 17}:D 1'1.12}:I NG: ..aaed Jai.red} (WIDTU X DEPTH) SQ. FT.: SEr ER (Y/N) : HYDRANT: CON :'RACIOR: NJ_ILING ADDRFSS: t*********************************************************************** CONTRACTOR LIN: : CONTRACTOR : MECHANI CAL I NFORMATI ON L j f,9t co 6'gee1Y 86AY77Ee _z4/c ?:AILING ADDRESS: L. .9*%Y/6 S,Ai0u5- -1-,-S4W #[� f i ELECTRIC: GAS: OIL: ENERGY CODE: WSEC: CCAL: WOOD: SOLAR: R: NWEC: APPROACH. PRESCRIPTIVE: UTILITY: POINT: HEAT PUI? SGC: COMPON IN'T : SYSTEMS : , f 1 * * * * * * * * * * * * * * * * * * * * * * * * * * * * 1 1 * * * * * * * * * * * * * * * * * * * * * * 2 * * * * * * * * * * * * * Y t * 14ECIUANICAL FEES DESCRIPTION ►` ESSING FEE ' )RK SYS'1'EM 01;1OVE/ I I: ERT WA'T'ER I IF•J, I'ER HTG 1-:2U I P (10 0, 0 0 0) 131'U IU'G EQUIP +100,000 PIPING - f OF UNI 1'S .TPUMP ,TPUMP ,TPUMP ,'TPUMP .TPUMP 1-100 BTU 101-500 I3TU 501-1000 BTU 1001-1750 BTU +1751 BTU 'I), G 1-100 1311i ' I' I G 101-500 I3'11J FIG 501-100 BTU 'RIG 101-1750 BTU 'RIG -11750 I3'1'U CONDITIONER 0-3 HP . CONDITIO`ZER 3-15 HP CO DITi0:ZER 15-30 HP CONDI DI I'I O: ZER 30-50 HP CONDITIO::E'R +50 HIP I'IIJ,TING FANS i'JPJ F1 VE COOLERS :)7, : i:D CAS APPI,I 7.`:CE NI4.1:R 1-10000 (AFM NUI•;BER OF YES OR NO PLUMBING FEES ITEM DESCRIPTION NUMBER OF PROCESSING FEE YES OR NO nil LETS SI UKS — SIIOWERS BATH TUBS TCHEN SINKS -- DISIIWA_SHERS GARBAGE DI SPOL;AL CII.Y1'1IES h1. ;fiER UTI LI TY SINKS - ELECTRIC WATER WATER HEATERS FIAOR DRAINS FIODR _SINES BAR SI NKS ROOF DRAINS LAWN SPRINKLER SEWAGE EJECTOR ATtiR SOFI'E-:ER URINAL I)RINF.ING FOUNTAIN