1992, 01-06 Permit App: 92000080 Mechanical Fixturesin 1 04,7p 0
Qe.kw o c, o u MECHANICAL PEHMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: S - ) 2 l L R -O bl\ V'-c)nd
CITY/STATE/ZIP: 5Io0K w A 'i 4 ab lo PARCEL NUMBER:
OWNER: 3 D Ann h I I, 95
MAILING ADDRESS:
PHONE NUMBER: day -J a
(Street)
(City/State) (Zip)
CONTRACTOR: C a I c_o &4(i EiJ CEiJfE►2 LICENSE NUMBER: r+4 CO G/C I %3 I Lk
MAILING ADDRESS:
DESCRIPTION
E. q3i d
(Street)
PHONE NUMBER: (5 q) 9'.2(0--&'9 / I
S1DOKAAle_ LJA Gig 2Ola
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
ii -As
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GAS WATER HEATER
GAS EQUIPMENT <100,t 'U > INCL ES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GA_S -.1041-0:00:(7,
BOILER/R EFRIG 1-100M BTU
t-. qn::•.w��.yy�MKvyppCv+�•:y:}i}:iNrynu.: ..^'YwjM�^m!_�+.-:r.t.QC �}T}:Y�YTv �.!S:�y!pp!!00
a��#7}.47�V1T17` k:'.:ar=i}c•::::- ::r} •{«Hifi
...:;_. _.oz.-_..,.._.,.::.:}::..�a..-..-:.su:�:bUtS�):Scx-io-_.:.•saaa�:,:<aG:c:� BOILER/REFRIG
�t�:
•;:•!7!+"
BOILER/REFRIG +1,750M BTU , .. ` ",
TIJMP AtRNCQNDTy�IEf3SNS
HEAT PUMP & AIR CONDITIONER3-15 TONS '=
HE1T RUMgfR CNb�O,NEI yxTNS�=_v>.h<.
HEAT PUMP &AIR CONDITIONER 30-50
'I+ PUMP CR CON> t
; ' + r fl> iS .
�.:.a:>:o_ ..nw:...,•...w«:.,.waN:� ..,c :,..v:...::.,:«caoo-,:,.«.•., �:..,..�cwo-.•«.�. a�:.:xaw�:c�a�__.�....
VENTILATING FANS
Yri.`w:4v:4i W Jx + SJn4Pi
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
•,'9 wYCY�
CLOTHES DRYER •
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHE
UNUSTED GAS APPLIANCE <400,000 BTU
•
ULINS`ED GAS APPLIANCE>400,000 OTU::::=i
USED APPLIANCE <400,000 BTU
USED APPLIANCE>4
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
x 10.00 =•
x 25.00 =
x10.00=
x 12.00 =
x 15.00 =
x1.00 =
x12.00 =
x 20.00' .
x 25.00
x 35.00. s
x 60.00 -=
x 12.00
x 20.00 =
x25.00 ,,..
x 35.00 =
x 60.00 _
x10.00 =
x 10.00 =
x 50.00 =
x10.00 =
x 10.00 =
x10.00 =
x10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
~ )
)c)o°
a..
+v
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4....4, ; - .
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., ' -.7.:--;••7,;...f••,--•:
_ , ,-
_ .,
,n: .:-�,,
: 4 }s <. w-
;.
., ::
.,
/p0°
SUBTOTAL
$ o2.200
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT/
FEE DUE
�-7 oo
=$ 7 / -
:)'son of Buildings
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