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1991, 10-14 Permit App: 91006817 Pellet Stove MECHANICAL PERMIT APPLICATION FORM 41°' Information Worksheet 8 ? JOB STREET ADDRESS: ---.) JR)7 5r,00.)c)(`?--h t G CITY/STATE/ZIP: 3-to G,t i (A2 `,-. PARCEL NUMBER: - J z/� -3Ja f OWNER: Ct( ) -Acct Lit. PHONE NUMBER: %d'7 - f9'7/ MAILING ADDRESS: sirYle._.- (Street) (City/State) / o (Zip) CONTRACTOR: (.6(1-,) . ( 7/(LL t7 Ue- LICENSE NUMBER: C.6cy, k27 4),-) /� �\ PHONE NUMBER: S3( $3C,/ MAILING ADDRESS: I ,0 - c=SJK c��Qa_ci F (l�C� ,9,71C) (Street) (City/State) (Zip) _. MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = .:;OQD$TOVI_MS.g.R .... ette :604.04 : / x 25.00 = 03,,Y,OD GAS WATER HEATER x 10.00 = GAS EQUIPMENT<100,000 B U INCLUDES :;::;:.;:. ;::;:: x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = GA '::.:IPI :.; ; ;{_ ._:,.>_..._;-::. _: > >_»:< _<:=> >_ =»_>> > ><»>> >>` _> >>< .:;; S ..... NG xg o 1T1-1='i -- :;::.>::>:;:>::.: ........::.: ..:::;:li ::::::, x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = RA-1 -` E;: ---- -v- - ----..,::.... :�-_::::--- 0.....�:;:>::;:»: ::::>::»>::>::>:_:::>::>::>::::;:;::>:_>:-=-.>::::>::::»l< x20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = B( L RE G ;OO1 OM B'l"Elr:itil::giii :,:<::<:-:>- = - .�.�..,.x,......,....:.:.,..,-,�-:.:..N:.:. -- �...: :::.. x 35.00 . BOILER/REFRIG+1,750M BTU '' x 60.00 = EA `PUMP I&AIR CQNDITIONEf3 0-3 TONS... =>:> : :;:i x 12.00 =._ HEAT PUMP&AIR CONDITIONER 3-15 TONS -- x 20.00 = HEAT PUMP&AIR CONDITIONER'15.30 TONS= :si: :>'; x 25.00 = HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = ifigagg:mmicimagamoNafAolownigivem x 60.00 = VENTILATING FANS x 10.00 = E-�-VA P:O RATIVVECO> L-.E::.RS---> >-:----m> ---mr gmnom x10.00 = TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 = TYPE tt HOOD ::;:::>: ;:;::::> .... ::-.... x 10.00 = CLOTHES DRYER x 10.00 = ;liANGE :.. x 10.00 = GAS LOG x 10.00 = MISCELLANEOUS(NOT COVERED ELSEWHERE x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GAS APPLIANCE>400000 BTU x100.00= USED APPLIANCE<400,000 BTU x 50.00 = ::::._;A.._PLIANC