1989, 10-12 Permit App: 89003999 Pellet Insert• r
IN r OrY.ATI ON WORKSHEET
PARCEL NUMBER:
STREET ADDRESS:
CITY/STATE/ZIP: �%%,�i'i��./.��/ 99>77 _ a
SUBDIVISION:
BLACK:
LOT AREA:
OF BUILDINGS:
F / A :
N
ZONE: DISTRICT:
WIDTH:
DEPTH: R/W:
C OF DWELLINGS: WATER DISTRICT:
NIAILING ADDRESS:
PRONE: G/ - f^2 j� 7,-c?
CI`T'Y/STATE/ZIP:
L2ON'1'ACT:
SEM/CRS: - FRONT:
LEFT:
PHONE:
RIGHT: RE.j,R
! i:} :PS 1 T F: c= E�=> i1 F f' 2 (z.Z. ,f _AZ
BUI LDING 1 i:FORMAT' ON
,'i):,i';'iZAC I'Qi: LI CENSE UUMI3ER:
1.) NG AI u ' ::;.`;
',j,(:iI1 TECI'/ENG 1NEER :
:?:1 I.I NG hr►i)iRI-: ;S:
PHONE:
`rr:I.L UN :
ADDITION:CRLNGE OF USE:
''CUP1.2rr IAAD:
UILDIt;G Ui1'.•.tisIONS:
X
BUILDING IIGT: STORIES:
(W I DTH X DEPTH) SQ. FT.
Vi:U I'J.I:FING:_ _---- 1 Iil.NDICT.P:
>v.,avade)
SEWER (Y/U) :
HYDRANT:__
dizost.d6u.
r.r`.. -.C1\T LI CI
CkiN fiZACIUR:
MAILING ADDRESS :
CONTRACTOR LIC#:
CONTRACTOR:
MECHANICAL INFORMATION
FAzCo !'AepeN_____8Eivme,ye
MAI LING ADDRESS: E 9J? J of f u . :sjob/�9 4/d9 --�• 7/�Gt/A
i -+�
ELECTRIC: GAS: OIL:
ENERGY CODE: WSEC:
CCAL: WOOD: / SOLAR : HEAT PUMA'
1 EC:
PROACH: PRESCRIPTIVE:
UTILITY:
POINT:
SGC:
COMPONENT: SYSTEMS:
,,t**t***x::x::********:*:*****si:*:xss:ss**ss:sx*****x**x::*:s****ts* *
MECI11,NICAL FEES
M I) FS C: R II'T I ON
-
F;SSING FEE - --------
,'.:L)RK SYSTEM
):;TOVE/I1:S ERT2
AT ER IJF.ATER
}iTG EQUIP (100, 000) I3TU
Ii1`G E(tJIP +100,000
PIPING - t OF UNI TS
':'i'UI;P 1-100 13'1'U
'i'I'UMP 101-500 BTU
I'PUIiP 501-1000 BTU
i'PUMP 1001-1750 BTU
1'1'311P +1151 I3TU
'r 1 G 1-10 0 13'1'U
P.IG -301-500 13YU
it IG 501-100 BTU
«1 G 101-1750 BTU
AG -11750 I3'1'U
CONDITIONER 0-3 HP
O_)NDITIO`iER 3-15 HP
C:O`.DI TIO:ZER 15-30 HP
0-Y:DD1TIO::ER 30-50 HP
C iNDITLONER +50 HP
1 13.TI NG PANS
Al VF. COOLERS
I) :YLR
G?.3 /PPLTT.`I';E
-'';i>I,LR 1-10000 CFM
NUI•:E3ER OF
YES OR NO
PLUMBING FEES
I 1 rM DESCRIPTION
PROCESSING FEE
`1OI LETS
SI li}:S
iIO'KERS
LATE E Til IIS
K1 1 :Ii}:N SINKS
I)1 SIUWASIIE}?,S
G?J P,? GE DI SPOSAL
CII.11'Ii1S WASHER
UTI LI I'Y S1 NKS
}:1,ECI'RIC WATER H}-J,TERS
rJ r»R DRAINS
I'I/OR SINKS
I;?.R S1 i:F:S
PC)DF I)::A11lS
I..'.�'N SPRINKLE_R
S1:«.75.GE F.JECPOR
WATER SO FI'I2: ER
URINAL
IDRINKING FOUNTAIN
NUMBER OF
YES OR NO