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1988, 09-07 Permit App: 88002667 Woodstove1 Q Q5 _vv L -Q--) C)C) r2c5 , L(_ INFORMATION WORKSHEET -4 PARCEL NUMBER: / Y 3 y _3 STREET ADDRESS: 5,244„!_6D- CITY/STATE/ZIP: k SUBDIVISION: CRE BLOCK: 25 LOT: ! ZONE: MA!. DISTRICT: C LOT AREA:605 F/A: WIDTH: DEPTH: R/W: OF BUILDINGS: OF DWELLINGS: WATER DISTRICT: .x. OWNER: �! MAILING ADDRESS : $ . � Z2 /�y' 4/ )K ITY/STATE/ZIP: (-/P64-e> �-S� Gf/CfSFSJA‘y PHONE: 55i k CONTACT : Aft://v6 C "-LLQ S&6 PHONE: SETBACKS: - FRONT: LEFT: RIGHT: REAR: )(PERMIT USE: ****************************************************************************** CONTRACTOR LICENSE NUMBER: CONTRACTOR: MAILING ADDRESS: BUILDING INFORMATION PHONE: ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: NEW: REMODEL: ADDITION: CHANGE OF USE: DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES: BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT.: REQUIRED PARKING: HANDICAP: SEWER (Y/N): HYDRANT: CONTRACTOR LIC#: CONTRACTOR: PLUMBZWG INFORMATION MAILING ADDRESS: ************************************************************************** MECHANICAL INFORMATION CONTRACTOR LIC#: CONTRACTOR: MAILING ADDRESS: ELECTRIC: GAS: OIL: CCAL: WOOD: SOLAR: HEAT PUMP ENERGY CODE: WSEC: NWEC: APPROACH: PRESCRIPTIVE: ****************************** MECHANICAL FEES UTILITY: SGC: POINT: COMPONENT: SYSTEMS: ********************************************* PLUMBING FEES ITEM DESCRIPTION NUMBER OF PROCESSING FEE • YES OR NO DUCTWORK SYSTEM %( TOODSTO /INSERT G' TER HEATER GAS HTG EQUIP(100,000)BTU GAS HTG EQUIP +100,000 GAS PIPING - # OF UNITS HEATPUMP 1-100 BTU HEATPUMP 101-500 BTU HEATPUMP 501-1000 BTU HEATPUMP 1001-1750 BTU HEATPUMP +1751 BTU REFRIG 1-100 BTU REFRIG 101-500 BTU REFRIG 501-100 BTU REFRIG 101-1750 BTU REFRIG +1750 BTU AIR CONDITIONER 0-3 HP AIR CONDITIONER 3-15 HP AIR CONDITIONER 15-30 HP AIR CONDITIONER 30-50 HP AIR CONDITIONER +50 HP VENTILATING FANS EVAPORATIVE COOLERS HOODS CLOTHES DRYER RANGE GAS LOG UNLISTED GAS APPLIANCE AIR HANDLER 1-10000 CFM ATR AAAmr_im i nnnn nic.m ITEM DESCRIPTION PROCESSING FEE TOILETS SINKS SHOWERS BATH TUBS KITCHEN SINKS DISHWASHERS GARBAGE DISPOSAL CLOTHES WASHER UTILITY SINKS ELECTRIC WATER HEATERS FLOOR -DRAINS - FLOOR SINKS BAR SINKS ROOF DRAINS LAWN SPRINKLER SEWAGE EJECTOR WATER SOFTENER URINAL DRINKING FOUNTAIN NUMBER OF YES OR NO