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1992, 01-02 Permit App: 92000009 Gas Log, Piping
MECHANICA''L PERMIT APPLICATION FORM Information Worksheet JOB STREET JRESS: /LI • 14-/v23 Ll)c1.L-S CITY/STATE/ZIP: 5pcK < <AJA gq°20(o PARCEL NUMBER: OWNER: WI) .4 Vta_ ).IL44 (e_.,s(Dv, PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: E ) Cr) C a (Z1)1'i,l C 1 rJ f F►2 LICENSE NUMBER: r r 4I CO & C., I i3 D lA MAILING ADDRESS: DESCRIPTION E • q3I D _5.perg3Ue_ (Street) PHONE NUMBER: (5061) qo?(o- 79 /I 0KAA1e- ),LJA 992Deo (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQUIPMENT+100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU YIMM-.Mv . '�ii,:37�VaV BOILER/REFRIG 501-1,000M BTU ^�,,,�.,,-ac^^. ice} -„r- :,n°�rw of WA,a < BOILER/REFRIG +1,750M• HEAT_P_UMP & AIR CONDITIONER 3-15 TONS HEAT PUMP &AIR CONDmONER 30-50 TONS = - Mor«r:.w. � •r. -^cam ,. .1:45. 14; 0„ b'i P VENTILATING FANS • -";'‘.:-:-t".='!•:'!=:-.1-21.- _AP :iA71 CQIOL : .w" .v iv .. w•'.GS.WP"7iWWw':i.G v-: �Q.VvZivivn+rs TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD) �•�;�r;.� :tea:,,:rho->::;.:••�:."<:..�u�':",::: uc.<:.::}�y '^;<•r•».,;.:,s::: :+i,.. :A..c:�:.,..i:.i" .SRY"Sx`3`.t-�f•.•'•2. .,�:.xsga'; .. �'+oi•:•: - . i, , CLOTHES DRYER •• M:tiv -p --y.'-: iii •<..v O•.: .j%f,� `- 5 } v? ::... .?:•.::xi�v,?::: vi:�'f+{SJi i:3:�S3'J`wk:�i:i:i?:'%}: n'v�.�vnin{2;:J�•%:'�(?LGy.�:i �fih.'Y�i:G� ♦nn.nns.....-:H.. ..ii•_.!i•wA. :ULI.IV:STED::GASB'.,,.:,..,;:,:;.N:C>.,.'. •: .:::4::::<a::»<:=?=>: ... :...".......::.... 0 E001000:.BTU::v.:a<:;x:.:a.;::::<:=_:�_:<:; USED APPLIANCE <400,00BTU GAS LOG ,..ik ..M' -Y iulis LANEggg • f:L7, „. VE.HEQ EL EiN -. v..u.,v.:: .:.-:..-.x•.vnv:.,,••. .. nv.vv.w;, iv.: ...:-•-: '. •.:P+. ,....; ... ., ..::.: UNUSTED GAS APPLIANCE <400,000 BTU v5.70:iC fiiJi AIR HANDLER<10,000 CFM AIR HANDLER >t1r000C1=1►it NOTE MINIMUM PERMIT FEE IS $35.00 SIGNATURE 'E.,,okane CcL�R NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x25.00= x10.00 = x 12.00 = -,..:-•.4a _4- x 15.00 -.- r •r x 12.00 t=i f.. -n: -‘,',1/: -It --:4-1= -- . x 20 00 = 1 --, : .4 -' .�-. - ... X25 00 -n' ti• I- X 35.00= '`.,- s 1,;�_ x 60.00 ¢. `' ,�``'''.� ) ".'r'.:. x1200.1.. -44-4,5):1111g74. - ' 45: 1 .= x 20.00 z._.�a.r%r A x 25.00•141001114/14404 - x 35.00x � <tri"'� t - p s'x+a w . 4,.... 1. .s -a-,.-- =i -=';' 4.6** 60.00 X 10.00 x10.00=.. �.. X 50.00 _ ,• x10.o0 = -- X 10.00 = x10.00 = x 10.00 = J v o� X 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ /! o° PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT 00 FEE DUE = S 3 1' "*!sionczBui.... .