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1991, 09-18 Permit App: 91005909 Insert, PipingMECHANICAL PERMIT APPLICATION FORM informaUon Worksheet JOB STREET AD D RESS: 6. ,9_3 23 A ci..! CITY/STATE/ZIP: Spo KA e- & OWNER: ACX re-DE/J MAILING ADDRESS: 5 /A-nno , PARCEL NUMBER: PHONE NUMBER: qty.- veci9 (Street) (City/State) (Zip) CONTRACTOR: rPt ICC) G 4 21:3F id CEA! i-Fg LICENSE NUMBER: FI41 CO C.4 e_ I -73 b U.' MAILING ADDRESS: f. q31D eA3u e_ - (Street) -._ , • . - • • PHONE NUMBER: (...5-09) VG, -e9/1 LJA (City/State) - , MECHANICAL WORKSHEET/FEE SCHEDULE AIR HANDLER <10,000 CFM AIR >:10,000 CH& NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE Spokaro 1222 pr.--,,,-44,.••fl 992040 (Zip) • NUMBER .. _ OF UNITS . X EACH UNIT c ' - -.' = AMOUNT' x25.00 •=1:1--,- x1200 =J 4-i.-;15.00,--4;;111.- ;X1.09,T.:::?,t-ii; -.3; -- 3 -- •,-. - '": • -4-,,----Aiirr,- :) r:127:cji.-Y--PF4t-;--cw:- g;'te-t "s;'"?fcf'':;-t-11t---.CT, 41::-$3TM:5.-c:2FIN FtE-,,,z-,,:e- :4..;;..4r,oilisaif X 12.0O , *24140:..;-45- :-*35.00:. 6003:141?;.;;; --;e 12.00ift:"; 2* 2ci.cid:::1.?" :,.... :6- :*25.99;r, .„:. ',7,.f2.1,2-1,4;51.:;,,It-•; ',?..?•;;:','12::Ei 4 , t.:. ,1 ." - :7-..i: .. -.:,,:z.::,..ii--.., -4,-•.z.,:v.:..i'i:L'S,.:3,-,-7-' : :.• '.:•;igY2":::-.':-.k•tecfr,:: .i.:m,.?;-‘,.....,:::51:1 :'-':'.-i'.47-..22-':?-it.W.1:t 0..,1C -f ,nti:I3i.!,:;;;:t:k5i4-6.V- izik::4...:,\.:,,:.,.-4 ,:47;:-Ii:t.o.,44474;7;114 7-ttrY'rt--‘"'•:--',2-•-*4-: 7:5(3022,,-,,f...,; 7-- i 6000'W.3.: -ii tioCT, - X 10 .00::-:4-1. -X5600,:41 x 10.1)bizitk, -ii 10.00 =1:3 11 d.odt:•&: X 10.00 = ' x10.00 x 50.00 x100.00 = x 50.00 = x100.00 = x 12.00 = x15.00 = -2,--XtFel..b.."--•',,F,:':. ?-7-: czi-:;:s•-:::,..y.:-4iti:w.a:: "=":-"' t ii...13iry.--7-Y-C.-ti:: 0::1-ic-t-T-Ft-N, ..,4Ait:lie::ti:',;;;;;;-? '‘.±1-t-4"':•.!; '.--7:---.-'7- :::::- SUBTOTAL I I O0 PLUS: PROCESSING FEE $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =s 31a,110 of Euiiciings Isr1(1\ - -