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1993, 04-23 Permit App: 93002848 Mechanical Fixtures L,‘ -oa (D , 301L . L-1- r.),- cr 3 MECHANICAL PERMIT APPLICATION FORM Information Worksheet b-"-- '9 STREET ADDRESS: e • Lt 2-it Rt c ' CITY/STATE/ZIP:S1Pr71U 01.- VO'R 91 24 (4, PARCEL NUMBER: OWNER: G-`NZ i4-114-• N.184-t t- _ PHONE NUMBER: MAILING ADDRESS: ) -�- (Street) (City/State) (zip) CONTRACTOR:'b " D DAER4( c1-0201..- LICENSE NUMBER:D 1 vG0 EC 1$$ L-C- PHONE NUMBER: MAILING ADDRESS: FJ• 1 15 W1let-D --- A SPOK 11- NVK 9 SZaV # (Street) (City/State) (zip) ,G.j 3 3 ZrJ?,C, MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) ' x 10.00 = :: v}>1:-`l Yom' '.<,:A.%:,` :1Cn *' ,' x 25.00 = GAS WATER HEATER I x 10.00 = t 0 b ~t , , _ :< > ;: > " } x 12.00 = I. 7-- GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = " x 1.00 = 'Z-- ,kttc. }awviC �-:.Agri) i� ,C}4,n:}:., ti. � }: . .,k,p�t.$u:"i�:in:fi., x 12.00 _ BOILER/REFRIG 1-100M BTU rY #1#0. #ta W PTIA �(`j,k� 5. .. : •:',' •,�`'� -..c.% x 20.00 = - 3::::::::,,,,-::::•.,,.},.,.w.Wx" . .�:%� :Cav"�\,���G�?� '�?<:i'A� G:;'�: :L}a-S;X',�2'.dif •a. BOILER/REFRIG__ 501-1,000M BTU x 25.00 = �`�y +�y ��„y�.....�.. .. t:q,... ;<: .:,; Ax 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = (;��.•,A� _ ?j •a ,jam' { x 12.00 = HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 = »F ' �i .gv 6. ` . ' : > <•:::i x 25.00 = f�t..n.};:.::.,>�:�•: x 35.00 = } HEAT PUMP&AIR CONDITIONER 30-50 TONS N lt2«•:'<:.:>,.;<.:x >�{ x 60.00 = ::.vi:}::.��},t-?ffiaN•h�': .G.v}}:A:vA.J: 4:}}ihsvW.,�'v. x 10.00 = VENTILATING FANS �y/:aY ., �y. r 4:.:1,..a.r n`.;. ; '><;; r<}<t::• x 10.00 = TYPE I HOOD(PER 12' OR 12' PTN.OF HOOD) x > : 50.00 = }: , w. Hv k ,Y : «: < ir x 10.00 = CLOTHES DRYER x 10.00 = •:iM:Q v9' :At. .. .:iso;;:::: 2'::::; � tir: ftif;i'.v.;:;':''M} ���+ t?,-4,;'};,..,' ,,,}s;Y d,' .;, ..,} :.. ,>, ,}v< . x 10.0 = 'Y��He.�,,}2<:}2•,.},,;. �<�'}�.,-�.?„..td'; . :oc\`''i4i::!(:j'::.,...? T4c :�T'; }�titG::> �<:y2 :.+:}:2::$'ov. :.tL:�. ti< .;$�'i�iS.n......,..,.,�:}�,...:�< GAS LOG x 10.00 = 1. `. .}>' x 10.00 ,,,-:: .,..:t„ x 50.00 = UNLISTED GAS APPLIANCE<400,000 BTU r �,' : >o�a r< .> � x100.00= rr l t ag EEE.EEEP....4TS 1114;..}:, <vw-:.;:�.�.�,. fts:,. vv ,•:.�:}.. <.:t "`•' "` � x 50.00 = USED APPLIANCE_ _ <400,000 BTU t:t:t,.,:::::, x Wytw ` < :: ry' v��. . t <, x100.00= :;EiSTn�r��,s:^Y �� �4�,NY•,�I•!i�i•��,�}M.M:i���ri.,.>'�C+•V>vi .x.v}.}i.•:.:v::t-n,. :{v}.t•-.i:5 i� AIR HANDLER<10,000 CFM x 12.00 = :::�•• ,�}:.:$ �,MY�}.,,Y..�,wt:F..}, �• v�•f} �t : �•.: x 15.00 = 6iR.:41,i.t :l� >� i t �QQA;•: , M x`•: , 'A}�v ��. "u::{t}}h . a' SUBTOTAL $ 24 PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT E IS$ 5.00 EQUALS:TOTAL PERMITActoa FEE DUE ,_ SIGNATURE 0.'%4 <Pei