1993, 04-20 Permit App: 93002724 Mechanical Fixtures tIMANtAL J ArieuIN1russet ,
03_ .�ay
, , Intonation
Worksheet
Job STREET ADDRESS: sPS S -�
CITY/STATE/ZIP: -,\,•4%- PARCEL NUMBER:
Avis+---�--z PHONE NUMBER: 91249 7 t t 7
OWNER: ,:r____
MAILING ADDRESS: S?C) C( (1,a, 4L0 21
(Street) (City/State) (Zip)
CONTRACTOR: 6 A41...-co m s PSG +- MA._r+-4.LICENSE NUMBER: R .k-i .Th ty-At t t. 0 t 7
PHONE NUMBER: qzz. Seo c)
MAILING ADDRESS: a 1\9 U. - it-v.3 S :Slit c.1 ill 3 Ca,a'1'__ _ ..- - * C4 Zo I.
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER l X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER x 10.00 =
HEATING EQUIPMENT <100,000 BTU '2- x 12.00 = 1Ji
HEATING EQUIPMENT +100,000 BTU. x 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4.00 =
GAS PIING (5 OR MORE. EACH: ) `2 _ x 1.00 = 'ice-'
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00 =
REFRIG 101-500M BTU x 20.00 =
REFRIG 501-1,000M BTU x 25.00 =
REFRIG 1,001-1,750M BTU x 35.00 =
REFRIG +1,750M BTU x 60.00 =
HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ x 12.00 =
HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20.00 =
HEAT PUMP & AIR CONDITIONER 15-30 TONS _ x 25.00 =
HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35.00- =
HEAT PUMP & AIR CONDITIONER +50 TONS _ x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE COOLERS X 10.00 = -
TYPE I HOOD (PER 12 ' OR 12 ' PTN. OF HOOD1 _ x 50. 00 =
TYPE IT HOOD x 10.00 =
CLOTHES DRYER X 10.00 =
RANGE X 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ x 10.00 =
UNLISTED GAS APPLIANCE <400,000 BTU _ _ x 50.00 =
UNLISTED GAS APPLIANCE >400,000 BTU_ _ _ x100.00 =
USED APPLIANCE <400,000 BTU -. x 50.00 =
USED APPLIANCE >400,000 BTU x100.00 =
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER >10,000 CFM x 15.00 =
SUBTOTAL $ )
PWS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT SI-4 p
NOTE: 0� E �i $35.00 lEFEE DUE $
SIGNATURE .