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1991, 12-05 Permit App: 91008408 Gas Log, Piping
a"15LI - L3 /5j :.:_CHANICAL PERMIT APPLICATION FORM Uo wC- 4 Eris Add Information Worksheet JOB STREET ADDRESS: ) 610 S .5- in/9 rne4C, !Cc' CITY/STATE/ZIP: ((J/9 `77 'lc? l 6 PARCEL NUMBER: OWNER: L-1 J 2 14 fnSe in PHONE NUMBER: letOYI-Q MAILING ADDRESS: F-14 (Street) (City/State) (Zip) CONTRACTOR: [ n ICCF'IfeDEiJ CEA] IFig LICENSE NUMBER: r4IC.00-�CI-73D1,( PHONE NUMBER: (SQq' V(0-g9/I MAILING ADDRESS: 6 •'3) D 3O-A9ue_ syym lme- Lori 992o/0 (Street) (City/State) (Zip) _ MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) 00 STO E/ SERI .' "`:, 1's:. , GAS WATER HEATERS::'::•:;_ =: GASMEQUIPMENT�<100,000':BnJ NCLUDESi;>_g,x<": GAS EQUIPMENT+100,000 Bill DUCTWORK) fa-ASSE7�f::.:'-::" e-„BOILER/REFRIG 1-100M r8Q1t:kRlF?E%lifGtD#4300Nj��,x�-,:r::,::;;.�<�:�;i: BOILER/REFRIG 501-1,000M BTU; - :t="=;: `-= =:rte; z lr gREpFtiC0fl00 WT>' OM'BT'U`.'r;::�n;�.,.�_ BOILER/REFRIG+1,750M ( *IEATIRUMP AlR CONDITIONER O- 3':TONS - %P I HEAT. Pump gA.RCONDITIONER .3-15TONS,'-=`_="=: ' - iHEATROMe$ AIRCOND TIONEWW15 3b TONS. =,; t <<' HEAT PUMP &AIR CONDITIONER 30-50 TONS `, c & '�IEAT,RUMR &.' IR GQND TIONEE146t1 TONS„H; f - 44x7; VENTILATING FANS::'.: :;;; -;,` : ; :- :c _ ^y :: _: EVAPORATIVECOOLERS -TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) =` = TYPE31 HOOD CLOTHES DRYER I:._..... ,..... - .. GAS LOG. MISCELLANEOUS (NOT COVERED ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED 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 ::;:':"ir.. .::::...:.:. .: 4;2 = a. NOTE: MINIMUM PERMIT FEE IS S35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x25.001=- x10.00=:. X12.00 =5.. x15.00 - x,1.00._= x 1200 = z 20.00:'= .X25.00:= 'x35.00.'', x 60.00' " :.,.:a)-i':::; s.. __._,... _.. - - -.. .',11.:::1-‘1:11:,? ,t.,.,:4-, , w i.2:... _. ' ,N?:^4= ;; `,.:� ; ....._.. -... 1. .... .,>� .` :,i:: _ zty.:... .S:i:_-:': , x 12.00. =-. X 20.00 =, .x25.00y- x 60.00 -Wt: x10:00 _' x10.00 =`., x50.00 =:: x10.00 =. x 10.00 = x 10.00 = x10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = :r1,, ,..:f-..,. `:r _ a,:::=?;: ac.;i.Y`:<i4:.a:';' -_ . ... P* °: „.......:::. _ "- .�. _ :,.� N .. ...:...... -,',-7-:--;. -_ ) /v" SUBTOTAL $ 00' - PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE CO = $ ,5)6 County Division._'...