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1991, 12-05 Permit App: 91008402 Woodstove5U ��5'E1 t.:F.CHANICAL PERMIT APPLICATION FORM `'I l U a A �� �DO� �� Information Worksheet o . S c� �3 v\ JOB STREET ADDRESS- 1 I t 5 -S. • (2-010; to %lid ©QI CITY/STATE/ZIP: S i" o K- 0 A cl ("0--0 4 PARCEL NUMBER: OWNER: Qf>,c) G fie; k r i i PHONE NUMBER: 9ac c9 - 8 4 MAILING ADDRESS: elf r- (Street) (City/State) (Zip) ` CONTRACTOR: r -) u- C4rz�EjJ CEJ if r FV2 LICENSE NUMBER: t- ►4ICO CSC I -73 D V( PHONE NUMBER: (SD4) cis2(c-x'91 MAILING ADDRESS: E • (131 D .5•p2A5ue. Sloo anre_ w(3 992o (City/State) (Zip) (Street) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) W00DSTOVE/INSER ' GAS WATER HEATER �V GAS EQUIPMENT+100,000 BTU DUCTWOR GA llPIMTOUTL`=s: BOILER/REFRIG .1-100M BTU _ BOILEWRECEFRIG 501-_1,000M BOILER/REFRIG +1,750M BTU F` c'A1R CONI ONE# _ 70N >.•7:_ HEAT PUMP & AIR CONDONER 3-15 TONS-- z " - EA" it M Atf OON4 .BONERS ?OI4§ HEAT PUMP &"AIR CONDITIONER 30-50 TONS -,-1::-", f VENTILATING FANS -• -� r `P LER TYPE t HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER • :RANµ- ....:..v.....:.v....... GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU UUNSTED 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 NOTE MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x25.00 = x10.00 = x12.00 =. x 15.00 x ;1.00. 5 ��. x 12.00 x 20.00 ' , - x 25.00 y, qtr`• x35.00 -..age x 60.00' x 12.00-=`;'±- x 20.00 . x 25.00 rt= �uf:; x 35.00 ' '1#-±•:2---,,--• x 60.00-1-"- x10.00 x10.00 _ 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 = (5 =- .. _ r . fi,: .; .J.;,,,44 .. _ - . - v _.. --� '.. 7-•••;Az--'' ..... _._ , . Mz < r .it -" � Y 4.• • L-. . -: :" ,.4 . =-.i. " _ _ y::�,4•'1e1. :v* **-");,.r - x;. 0- .:x • .,.; v c-.,...... .. - ? . }i,i,_ yc -•,.�:, �. ., '- "�G�w�.'X:1-- •n. -i ,-• 5_:/._• 1----:;',-,----• - ..' t> "V ','�. •_- ,.- . =--- $ - SUBTOTAL $(-DS-- PLUS: PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = S �� cunty Divis o