1993, 03-24 Permit App: 93001781 Mechanical FixturessammummiL regms Amt.
` Inroreatian Worksheet
JOB STREET ADDRESS: .0 a/ 0 C
CITY/STATE/SIP:
OWNER:LC)4..-r
MAILING ADDRESS:
(Street)
CONTRACTOR: Q, A e �►,s k�}G t M._�-s6. LICENSE NUMBER: R ip era Ito Q Z_
PHONE NUMBER: <it1 - Srt o c
Lep
PARCEL NUMBER:S
PHONE NUMBER: ' ' C /
(City/State) (Zip)
MAILING ADDRESS: 1\ a lL w,s s s t ei c ' 3 'e �-�--� \k^^iia+ 44zest.
(Street) (Ci y/State) (Zip)
Ori"'G
MECHANICAL WORKSHEET/PEE ScnDULE'
NUMBER X EACH
DESCRIPTION OF UNITS UNIT
g AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PINING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU.
REFRIG +1,7501: BTU
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
HEAT PUMP i
HEAT PUMP &
.HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
. VENTILATING
0-3 TONS
3-15 TONS
15-30.TOWS
30-50 TONS _
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD"
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG -
MISCELLANEOUS (NOT COVERED ELSEWBERRE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM.
l
x$10.00
x 25.00
x 10.00
x 12.00
x 15.00
x 4.00
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 =
x 12.00 =
x 15.00 =
n
MOTS:
SIGNATURE
•-m4-srs
SUBTOTAL
PWS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
estaoste mot Re PUTRIStsor IMO um,