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1991, 07-31 Permit App: 91004656 Furnace, Piping-1 JOB STREET ADDRES / CITY/TAT;/ZIP: MAILING ADDRESS: (Street) r (City/State) (Zip) CONTRACTOR ` 64K Q LICENSE NUMBER: Ito n 4-4- l L q PHONE NUMBER: q 2 2 -SSD c) rr MtteNANIbiL rtnivii s urrui iu sun runts Information Worksheet •4' PAROlgit NUMBER,, y,iir PHOME, )NUMBER: MAALINa k-- (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION NUMBER OF UNITS X EACH UNIT = AMOUNT DUCTWORK SYSTEM WOODSTOVE/INSERT GAS WATER HEATER HEATING EQUIPMENT <100,000 BTU HEATING EQUIPMENT +100,000 BTU GAS PIPING (1 - 4 OUTLETS) GAS PIVING (5 OR MORE. EACH:) REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-500M BTU REFRIG 501-1,000M BTU REFRIG 1,001-1,750M BTU REFRIG +1,750M BTU HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & VENTILATING AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER FANS 0-3 TONS _ 3-15 TONS 15-30 TONS 30-50 TONS +50 TONS _ EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' TYPE II HOOD CLOTHES DRYER RANGE PTN. OF HOOD) GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE) UNLISTED GAS APPLIANCE <400,000 BTU UNLISTED GAS APPLIANCE >400,000 BTU_ USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 BTU AIR HANDLER <10,000 CFM AIR HANDLER >10,000 CFM x$10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x 4.00 = x 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 50,00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100 . pi x 12.94 _ x, 15..= )TOTE:. SIGNATURE • ti:1dFY $35.00 ka ne ./...w.i- 111461101114111 SUBTOTAL $ 3"1 PLUS: PROC49 aU EQUALS: TOT FES: 111 111..wib"wi.i ! WM= an i