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1992, 05-13 Permit App: 92003334 Gas Log, Piping..:ECHANICAL PERMIT APPLICATION FORM aa' Information Worksheet \do JOB STREET ADDRESS: 109-061 - V1(1/35/ Oh CITY/STATE/ZIP: SpO -, u.A CIg-Iob /� OWNER: � Avrvn ry\P v '-A n. PHONE NUMBER: 9o2.c2 - 300& MAILING ADDRESS: PARCEL NUMBER: (Street) CONTRACTOR: Ftg- IC\ 64eL31-J CE.I/F,2 LICENSE NUMBER: F14ICOC&CI73bLA PHONE NUMBER: (S09) c7J(47-?9 / MAILING ADDRESS: E. (1310 -30 3U€. si'nLAAJe- LJA 992o& (City/State) (City/State).- (Zip) (Street) _ MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) :WOODSTOVE/INSERT _ .: 4'.r E GAS WATER HEATeR�•-.'.:_...''........ _ _ .... GAS. EQUIPMENT-t100,000:BTLt INCLUDES GAS EQUIPMENT+100,000 BTU DUCTWORK)-:t--- GASiGASielPING (EA OUTLED;V. BOILER/REFRIG.1-100M BTU - -•- BOIL•.ER(REF RfGrt014500M13Ti L`.. `� BOILER/REFRIG 501-1,000M ' -: (BOI /REFF1fGzY 0001` OM BTIT >>>': BOILER/REFRIG+1;750M BTU, ; =:•.'-:t=_ "'_,--._ I--- -'HEALPUMP &AIR CONOFUONER'D=3 ( -'r; HEAT PUMP & AIR CONDITIONER 3-15 TONS; Y .+1EAT RUMF< ''AIf-CONDLTIONER155430<TONS ' -<_.;ro 's' HEAT PUMP E AIR CONDITIONER 30-50 .. 1EAT,P,17MP8*1RCONDITtONEP.`+50TONSd == VENTILATING FANS: -- -="-7:t-_"r'- h - EVAFORATIVE COOLERS :... _6,t, / x-- - '' TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) '-="_. CLOTHES DRYER - - RANGE'.' GAS LOG MISCELLANEOUS:(NOT COVEREDELSEWHERE_ a UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPUANCE00,000.BTU USED APPLIANCE <400,000 BTU USED:APPLIANCE>4-O0,000-BTU::.:: .:° "::`_:..:_:7-- AIR HANDLER <10,000 CFM AIR'HANDLERs10,000 `+S NOTE MINIMUM PERMIT FEE IS 535.00 PP). NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00_= x 10.00 =. x 12.00 = .... x 15.00 -:="`; x 1.00: ='; -. X 12.00 = _i ; - .. ,. a . - .. .;. .:- i.../.; ::..._..:::. s' -. - fc.:--.� -:i:a 5-/-..:-; :,,,_ ..a z:; 4r _. _ ;.:1:71 -:::. L x20.00' ! _x25.00, a_Y. X3S.00.T 1 x60.00- - x12.00 `.. x 20.00 -ar X 25.00-z is s x35.007-4:.' x 60.00 -217-:. -x10.00-=� x10.00.,` = x50.00 _ x10.00 =. x 10.00 = x 10.00 = x10.00 = x 10.00 = x50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = .:k:;A,',.,, -=�.:: it:.::-?;-.? l- ...Y-:...: ti:_- %.. -- ~•; z..l ,xs .:-;v; _ iu - . ,." ,; 'l" -_ -_.-. _._ .- .' ^:.kfses-, -4.-4.':g'.S : +-. tr1 ,+Jat.=':: w.._ ....: ' _ _ : ;-;. =.=. , ",:..77•-_ .. � . ( /b� SUBTOTAL g 1/o0 PLUS: PROCESSING FEE +$ 25.00 EQUALS' TOTAL PERMIT PEE DUE 27 00 = S SIGNATURE ntv Divi