1992, 08-19 Permit App: 92006612 Mechanical FixturesMECHANICAL PILR14.41 APPLICATION FORM
// L-/ / rInformation Worksheet
JOB STREET ADDRESS: /4) '/72 3 /fGL- „4
J /
CITY/STATE/ZIP: Joisct.YJ e ii(.�. i I Z%� PARCEL NUMBER: '75I `��� 1 J
OWNER: /C.I'i�c 02700 rte- PHONE NUMBER: / r7` -7-?0,/ �' /
Pep )/6411 s
MAILING ADDRESS: W 72,3 /--//f/ a�r�
CONTRACTOR: F-1 I C t
(Street)
(City/State) (Zip)
(St 1 iL)1 EIN.1 f Fg LICENSE NUMBER: c---4 CD & L V73
MAILING ADDRESS: e - 6131 C 5p P_ (-1 <'tf
(Street)
DESCRIPTION
PHONE NUMBER: (_S0(1) ci�?(n �' % I
.4 riAi
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/iNSER� :. ..
GAS WATER HEATER
GAS EQUIPMENT<100,000.BTU
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PING;#FA
. t BOILER/REFRIG 1-100M BTU
8011 IAEFI IG00 -50{1Nfi ?
BOILER/REFRIG 501-1 ,000M BTU
•
SBOIL �/REF"RIG 110001 -1,750M BTU
BOILER/REFRIG +1,750M BTU
c.w
PUMP &AIR ONDITI6N.ER
HEAf PUMP & AIR CONDITIONER 3-15 TONS -- -
HEAT PUMP & AIR CONDITIONER 15 30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
;HEA? PUMP &AIR CONDITIONER +50 TONS;.
VENTILATING FANS
EVAPORATIVE COOLERS_ -
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOO
CLOTHES DRYER:;.:.;;:;.. ..................:.......... :.....
RANGE
GAS LOG
MISCELLANEOUS''(NOT COVERED ELSEWHE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINS.TED GAS APPLIANCE>400,000BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE:>400000 BTU
AIR HANDLER <10,000 CFM
AIR.HANDLER>10 00Q.:.CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
).v 99 2 o&
CZip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00
x10.00 =
/0.00
x 12.00 =
-�� x 15.00 =
x 1.00 =
r2. c»:
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
.
x 60.00 =
x12.00=.
_. _
x 20.00 =
x25.00=
x 35.00 =
x 60.00 =
x 10.00 =
x10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x10.00 =
rU•UU
x 10.00 =
x 50.00 =
x100.00 =
x50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ a a00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
4°-C2
FEE DUE
=s L-1-)
C
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