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1995, 05-02 Permit App: 95002858 Fireplace, Piping
q5- zg 58 MECHANICAL PERMIT APPLICATION FORM E Information Worksheet JOB STREET ADDRESS: TSI ,� �' lt9LLC CITY/STATE/ZIP: SP3IL- -(r - (k 97272 OWNER: S'94J✓ tv3 Ct 1CtffLr MAILING ADDRESS: CONTRACTOR: PARCEL NUMBER: PHONE NUMBER: iffir 926 -6265 (Street) (City/State) A//f77T61..117 CtfiniA%/t*, LICENSE NUMBER: MAILING ADDRESS* 9h C DESCRIPTION (Zip) A/4-j747CS /oac 9 PHONE NUMBER: 62t-ri,tgli2r0-3/47.a�j /alt /44 tfL 49- gycbh (Zip) (Street) . (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WQQDSTOVE/INS "C .517 GAS WATER HEATER :4701.1 Mg.tt ailitF, nt�0;;' Tu°::1NGLi1DEs GAS EQUIPMENT +100,000 BTU DUCTWORK) t&Ptp1N41414tiT(71 BOILER/REFRIG 1-100M BTU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG +1,750M BTU 544: PLtialii a TJq E ,p .p%T<?N$ HEAT PUMP & AIR CONDITIONER 3-15 TONS `E Fa4T'RlllrlP b°A..f 1. f? ti ..P:y67376 W HEAT PUMP & AIR CONDITIONER 30-50 TONS i6t P4'1Mp<a&„„Ap?<CONp1,Tt5aTa (sC: VENTILATING FANS EVAp01 AT112061 tEB TYPE I HOOD (PER 12' OR 12' Pm. OF HOOD) CLOTHES DRYER GAS LOG ItvilSCEls1 Ah1 OCl'S It1fit49V IaaC)''aI fftiEir UNLISTED GAS APPLIANCE <400,000 BTU st, LINS;7'EI(.C.,11S ANi?t IKS: yAfjQi USED APPLIANCE <400,000 BTU H SPt) Af?PL,tANPW.1(n070wer AIR HANDLER <10,000 CFM "XIR HMN OEF1°: EaltrA CFM saEs NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE Sp NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x 25.00 = x 10.00 = x12.00 = x 15.00 = x 1.00 = x 12.00 = x20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = 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 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = .. - lace/ /Z. ' / /, a7 SUBTOTAL $ /g, to PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 3s kane County Division of Buildings