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1993, 05-06 Permit App: 93003231 Gas LogMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: IT 4/47/S /ll? leaf ` CITY/STATE/ZIP: Kd 4J - gei 21 C. PARCEL NUMBER: LLA--egke PHONE NUMBER: OWNER: ®rvt 1k.*, MAILING ADDRESS:. --C %-6-fl3 I. /9 e3 928" �(I Street (City/State) Rip) CONTRACTOR: ►cay.-0 Vit aA ViLvtc,kb LICENSE NUMBER: SV K/4 -1‘A. F 0"7'1 /- PHONE NUMBER: E/q g 6 2 MAILING ADDRESS. /C/ Z Z- S6 S 49,--e- (Street) ,-c-(Street) . (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) T1!: OO�7:4;'41Y #.4`t�7 :�:•.<.. ,.J :n .,> : 3€{}k} y {>.0 :•.:$ : {$.h{ $ ...,.::.+.,•:::.,a.,,a,.:::m.:.•..�,w�:�{,rrr.:•:.,..:::x,:,•:,,�Gr.:•.:a:::}...,..}.{:•}:.r.,•:.,•:.{;,F.::t:�.c�Y. GAS WATER HEATER !F:.S'iv+{:!Fw+^`a}•'»•':.v::.•••��G`.a�a�'`�`!cG;*';Mva*.!4 GAS EQUIPMENT +100,000 BTU DUCTWORK) •{Y. �.z. Vii• r,�s�. - �;;.^;: BOILER/REFRIG 1-100M BTU hw:. nom:::. .::.fi.xwa9'i.,W}AFfu.�•. : BOILER/REFRIG 501-1,000M BTU Entlffi n ATP'. # {k: inr�•vC i�{6+ •C. M BOILER/REFRIG +1 ,750M BTU ."Yr{:c:n }:$ :{{i�,}{��;�,'•�7-timet;}-<, HEAT PUMP & AIR CONDITIONER 3-1j5,yTONS• tAlft:t3t":!!•T-9..9.N947137NsER 0-50 } c ' t ? ►tl ,a{'4..:...7..77.,;776 VENTILATING FANS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) gra CLOTHES DRYER . . }:,vxr{{4}: Y} }f,.r•Z. %ri'+y%r•{•${'r'r$�: d,�M•.{ti! .•. �.�lti`'ti'fi�:Y,i'•`.iC{•�Af�. ,:"i`•i {. , py . GAS LOG __ 5: yy►,:.r.r��� .yx ff��::..[[yy``'' Y�.:.,�.},,.. �:• �y..:.�i�,n}ys .,,�,•,�: {; .�,..r<, Es. UNLISTED GAS APPLIANCE <400,000 BTU • Y,»,••>;••+•t:{.;:.,,.}+•y1•++c+»r.,,y.•..• yY{g}• �,•,.:,,3 ;., fi; '2 { , •S;i : ?:: ! !:MtitW. S ,:-.: • e• • .,:. ,.gig€ :. USED APPLIANCE <400,000 BTU $::r.}':;:: • .:$ xrm:.;${:p{•:rr:' f.rr.•Yrr'i•}:•}z•}}%r{nrr{::.,v,;b}Y:.}v qrY,�{.. •,w„$;}i. AIR HANDLER <10,000 CFM �y ANbLER {. ?>$:.$}:.}.:��� NOTE: MINIMUM PERMIT FEE IS $35.00 4'72z3 (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 = x25.00 = x 35.00 = x60.00 = x 12.00 = x 20.00 = x25.00 = x35.00 = x 60.00 = x 10.00 = x 10.00 = x50.00 = 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 = x12.00 = x 15.00 = . l /6} SUBTOTAL $ (0 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 3 S Snnkann Cot Ilivicinn of Rttildinnc