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1992, 03-25 Permit App: 92001850 Woodstovetea- rg5b : -= HANICAL..cF- ERMIT APPLICATION FORM Information Worksheet ✓ G JOB STREET ADDRESS' 13 �' ' L 10 .ate �-- -b r - 7�`� CITY/STATE/ZIP:SQo ICS (A 99 2D is PARCEL NUMBER: o�/ © U 3 ` �O'P7�41 OWNER: OV -1c PHONE NUMBER: MAILING ADDRESS: ' . G '�f M IC.A 4f- �> (Street) (Ci;y/State}. - (Zip) r CONTRACTOR: C 4) CCS C-jt42,pEjj Cf,� f Fye LICENSE NUMBER: F+4I CA CSC I -73 D tA PHONE NUMBER:�SDQ) MAILING ADDRESS: 1E. q3) D .5Qe0que— !`AA1e, t,,-�A 9920& (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) r"• ....,..m..:�:..u.:.M. ..,:...Www.,..w...,.:w:w.:-::::..atria.... �:ax::x:ata..+.;..xw xattw:a�w:.;.w..w::»f::>r::x;,i� 8�:• GAS WATER HEATER-.:- GAS EATER- GAS EQUIPMENT -+100,000 BTU DUCTWORK); r :}v G ` w'} •. .. - - '.wt�vri:: .. ......::iv: .. ... •_ wNwwirivvvirlw•iiM BOILER/REFRIG .1-100M BTU—� a..aec.a...a.amo..Yat:•[d�:C•o:c:..:.+... -x.�.'.xd�C'.rt BOILERlREFR1G 501-1,000M BTU`�" =-g` BOILER/REFRIG+1,750M b.:: > M AIF3 GOND ONE#.5-3 'I'flNS HEAT PUMP $ AIR CONDITIONER 3-15 TONS.�--=L �EA�'= •. M .:>:1I �QN» .SON. _ �Ti�1�IS:a_<:�<:Y< -' HEAT PUMP &AIR CONDITIONER 30-50 TONS` � w= VENTILATING FANS >� c:Mr ;.::......X..--- TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)- -" .......: :....... CLOTHES DRYER GAS LOG NOTE: MINIMUM PERMIT FEE IS S35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = X 25.00- x 10.00 -- x 1200 x15.00-' 20:00 X 35.00 ;t`r x 60.001' iZ� -'x1200 _=='. x20.00= x 25.00tt:tea ' x x 60.00" 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 = 5 _. _ 7, 0.1'z _ r= j r�ca:.1ay:x '�'.r>`b �'*^i.:'�• -. r+r�+•? :..� •.�;�,.� �' ���rw .. .. ;. - '--= SUBTOTAL 2Ste° PLUS: PROCESSING FEE +s 25.00 EQUALS: TOTAL PERMIT EE DUE I=s s��