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:
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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