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1993, 05-28 Permit App: 93004068 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM ,�v� Informati n Worksheet JOB STREET ADDRESS: J 71�0c ` Mc'" ` e��4 CITY/STATE/ZIP: 61) KkKe %jtv'�. PARCEL NUMBER: PHONE NUMBER: OWNER: 1%'iw�;ti V`r t'r MAILING ADDRESS: (Street) CONTRACTOR: Aijr&, MAILING ADDRESS: DESCRIPTION /57.)3 J1L (Street) (City/State) 4R1.# 11364 (Zip) LICENSE NUMBER: PHONE NUMBER: B 3s'c C) MECHANICAL WORK ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER .4.�.,A�?!y?Fi;4[J.V,.:��<i���'.*� 4 $::::'.:`.:'<� �<�i:7:`!:�:�<::'•..�':::".':::::3::•'.•::s::':i::::.^..ii vi; .:vi>:�-i:.i; GAS EQUIPMENT +100,000 BTU DUCTWORK) �::: :::i�.'��Trt...`.: i' :i;${�:�:•IG}:?.ii:?;: ii4i:Sn:':: i:. .::::: .::::: .:::::: .: BOILER/REFRIG 1-100M BTU BOILER/REFRIG 501-1,000M BTU Amu BOILER/REFRIG +1,750M BTU HFATf'UMP AIR::C !NDITIONER0_3TONS;:x:;<::: HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS <..:... ti r�>x:ras�rt�rrt;:'t�� - • -: [•.'iK14�'•>� VENTILATING FANS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG UNLISTED GAS APPLIANCE <400,000 BTU USED APPLIANCE <400,000 BTU AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 (City/State) (Zip) - NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = jp, b6 x 12.00 = / x 15.00 = /5 ; o Cy x 1.00 = `o x 12.00 = x 20.`00 = x 25.40 = x 35.00 = x 60.00 = x 12.00 = x20.00 = x 25.00 = x 35.00 = x60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ -27 c: PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ ©b SIGNATURE Snnkann County Division of Buildings