1993, 08-30 Permit App: 93007682 Mechanical FixturesMECHAN!CAL PERMIT APPLICATION FORM
Information Worksheee
;qtr.JOB STREET ADDRESS: 4 J97/ 7
CITY/STATE/ZIP. �f' iv2/ PArCEL NUMBER:
/ / ' C.)
OWNER: 'D1�j- r FNriNlj PHONE NUMBER: v2- &_W
MAILING ADDRESS:
(Street)
CONTRACTOR: C_Ob1d
MAILING ADDRESS: /PO 6d i577
(Street) / (City/State) (Zip)
(City/State) (Zip)
LICENSE NUMBER: CT COT Q PM,6A1
PHON NUMBER: /
DESCRIPTION
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER
OF UNITS
X EACH
UNIT
- AMOUNT
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
W
INSERT
GAS WATER HEAT
GAS EQUIPMENT <100,000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
ILER/REF- - OOM BTU
BO1LER/REFRIG 101 500M BTU;
BOIL ER/REFRIG 501-1,000M BTU
BOILER/REFR!G .1,0001 1,750M` BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AD COND TIONER 0--3 TONS';;
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEA''.PL'YP & AIO COIVD#TION�ER'15_3
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & ATR CONDITIONER'+50;TONS•
VENTILATING FANS
EVAPORATIVE COOL ERS;:
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE t.HOO ,_,
CLOTHES DRYER
M EL LANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPUANCE <400.000 BTU
UUNST1ED GAS APPLIANCE >400.000 BTU
USED APPLIANCE <400,000 BTU
USED APPUANCE>400.000 BTU
AIR HANDLER <10.000 CFM
AIR HANDLE! >10.000 CFM
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
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 is
x 12.00 •
x 15.00 at
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
ccr_
Spoka.nn Cnun.'v Division of P,ui!dings
Wes 13()? ProPdwav Avnn,,n Snntrnnn WA O V)(n ton)
REGISTERED AS PROVIDED BY LAW AS A:
U C T (. UIQ 1:i (Ji.. ' L rr C
P p ;.,OX 15174
i+2155174
SIGNATURE
ISSUED BY DEPARTMEN IF L BIR AND INDUSTRIES