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1991, 10-08 Permit App: 91006626 Pellet StoveMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: E - VYY0n 43n: }-w4 CITY/STATE/ZIP: (ice .MAcfL6s.. Lc) A q67 I to PARCEL NUMBER: OWNER: Si y-1,1 Si, iAN-Io&i PHONE NUMBER: _509 9�6,-0(//6 MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: F I u G 1412DE JJ C.EjJi-E✓L LICENSE NUMBER: r44IGO &C. I '73 b to PHONE NUMBER: (5oe q0?(, -g9) ) MAILING ADDRESS: E • q31 d Sp2A9ue. S�OkA�1er 1JA 992D(0 (Street) (City/State) (Zip) MECHANICAL WORK DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) �'��•���,}�v .•.irx•......�yy.�.... ....s •'15«;i `:i:35j-•:--vi ��ir :::}:!{.+vt.-:�:`'i'•, n. Y`'�-:•�'.?`.�,}h•:}:::: _I �,�vM, .�R:�Y.����� •!�s 3'+iiivY'i>:::ivhi.. {v.::: -::.tit f�X kr.,,-.,.,.. •:.{Y.scviv^,�;'w;: *r .ax ��a..;oiCb`c.°... �.� GAS WATER HEATER v..,,: 1wtrv,v GASrvEQUIPMENT +100,000 BTU DUCTWOR GA.:::IPING.:/P ::OU?O��� ry BOILER/REFRIG 1-100M BTU .��i rju�ar1'�� •n �0.#-::0: _. .J .T 'x r.{ x Tv rv4 4 Ari' fM- :M::-�5.: vrv'.•:: r� Vrvwawv .4n. '+. ...n .. .. _.. •-- BOILER/REFRIG 501-1,000M BTU.; BOILER/REFRIG +1,750M BTU i HEAT PUMP $AIR CONDITIONER 3=15 TONS HEAT PUMP &'AIR CONDITIONER 30-50 TONS- . - - �• VENTILATING FANS w.` �y t� fit- fir aaawcc..sow..���'�S•:''`.,S-,"r.Ma..:wz::.�..•���ec�'•r'',c�,.a:�' of t�l.�. - . ,1.k„G���: TYPE f HOOD (PER 12' OR 12' PTN. OF HOOD) <. : " -ti{ij:=`,. -1-Rsrr.Y.'•. is i.}• NYf.^Gn�](?lt :v Tf?_ X-wx �:yt.N.::.; ::5.}:ti'-:X-{ �v Yom%/' .t„-�._sntix' ,+ - :: f:-.•: .- Yk" iRtk�`::k -; :'44:.,:.,ri.:;.c^ Fit/4os1'�S`•c CLOTHES DRYER 1:44714.7"1 GAS LOG" UNLISTED GAS APPLIANCE <400,000 BTU UUhiSTED. GATS AI'PLIANCEa400•,00• 0 BTU: USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 BTtj <> AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE 44,4 NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = 3:5 '-•_, x 10.00 - x 12.00 = ti, -, x15.00= ,< -. .p. .. x :1.00 = . - e A^, -z-,; .-„:;;%.=', ., f.x 12.00 = x20.00„ x25.00 '.: •,-:. 17;;. -t. x 35.00 =may w,:� fi Y. .- .<_ x 60.00%=1,,, x 12.00` = y r t -: h • x20.00 3 x='t`Q,,• .. %= • x n= 25.00. , 4, x35.00 �.. x 60.00 -=''-- x10.00= x10.00 . 4 . x 50.00 -" - x 10.00 x10.00 -. x10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ o2S - PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =5 50 unty Division of Buildings