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1989, 01-06 Permit App: 89000041 Pellet Stove f ' INFORMATION WORKSHEET PARCEL NUMBER: ��J l //1 STREET ADDRESS: 2j g-6)S - CITY/STATE/ZIP: 42.0 ) A) /1 • 99 7-0C SUBDIVISION: BLOCK: LOT: ZONE: DISTRICT: LOT AREA: F/A: WIDTH: DEPTH: R/W: 5f) # OF BUILDINGS: # OF DWELLINGS:. WATER DISTRICT: OWNER: �� N ���!I t C L W PHONE: - 9'Z-'(- 15-2-1-(6( MAILING ADDRESS: 3 go S t CITY/STATE/ZIP: �� IL G' / W04 99a6,6 CONTACT: PHONE: - - SETBACKS: - FRONT: LEFT: RIGHT: REAR: 1 PERMIT USE: C h'STYV--C- (A..) 'z _ **********************************.******************************************** BUILDING INFORMATION CONTRACTOR LICENSE NUMBER: CONTRACTOR: PHONE: - - MAILING ADDRESS: ARCHITECT/ENGINEER: PHONE: - - MAILING ADDRESS: NEW: REMODEL: ADDITION: CHANGE OF USE DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES: BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT. : REQUIRED PARKING: # HANDICAP: SEWER ,(Y/N) : HYDRANT: PLUMBING INFORMATION • CONTRACTOR LIC#: CONTRACTOR: MAILING ADDRESS: *************************************************************************** MECHANICAL INFORMATION CONTRACTOR LIC#: P C 1 6"- CONTRACTOR: T ''' c(`f MAILING ADDRESS: I ���� S • K. ` ELECTRIC: GAS: OIL: CCAL: WOOD SOLAR: HEAT PUMP ENERGY CODE: WSEC: NWEC: UTILITY: SGC: APPROACH: PRESCRIPTIVE: POINT: COMPONENT: SYSTEMS: *************************x**x**********x***x*************x******x.**x**x**x* MECHANICAL FEES PLUMBING FEES ITEM DESCRIPTION hd:ER OF ITEM DESCRIPTION NUMBER OF PROCESSING FEE AV OR NO PROCESSING FEE YES OR NO DUCTWORK SYSTEM TOILETS WOODSTOVE/INSERT 1 SINKS GAS WATER HEATER SHOWERS GAS HTG EQUIP(100,000)BTU BATH TUBS GAS HTG EQUIP +100,000 KITCHEN SINKS GAS PIPING — # OF UNITS DISHWASHERS HEATPUMP 1-100 BTU GARBAGE DISPOSAL HEATPUMP 101-500 BTU CLOTHES WASHER _ HEATPUMP 501-1000 BTU UTILITY SINKS HEATPUMP 1001-1750 BTU ELECTRIC WATER HEATERS HEATPUMP +1751 BTU FLOOR DRAINS REFRIG 1-100 BTU FLOOR SINKS REFRIG 101-500 BTU BAR SINKS REFRIG 501-100 BTU ROOF DRAINS REFRIG 101-1750 BTU LAWN SPRINKLER REFRIG +1750 BTU SEWAGE EJECTOR AIR CONDITIONER 0-3 HP WATER SOFTENER AIR CONDITIONER 3-15 HP URINAL AIR CONDITIONER 15-30 HP DRINKING FOUNTAIN AIR CONDITIONER 30-50 HP AIR CONDITIONER +50 HP VENTILATING FANS EVAPORATIVE COOLERS HOODS CLOTHES DRYER RANGE GAS LOG UNLISTED GAS APPLIANCE