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1993, 06-18 Permit App: 93004775 Mechanical Fixtures
- ' MECHANICAL PE1W APPLICATION FORM 1,--• - L 7 7,5-- Information Worksheet •Aji-J\ , C ' JOB STREET ADDRSS: , _. - - - ) • , , CITY/STAT /ZIP:- , ;1. ... )A ip ) . PARCEL NUMBER: 0 ,i e.' OWNER: c./"Vit--1 1,1114),C,. PHONE NUMBER: A o - • • MAILING ADDRESS (Street) (City/State) (Zip) CONTRACTOR: 0(5r0C.) C !71 ,9f UCENSE NUMBER: A-)0/(0/)-4/ --/reC PHONE NUMBER: I- --7 ' - L C --- ( MAILING ADDRESS: 3 Li - .. (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH - DESCRIPTION OF UNITS UNIT = AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) . x 10.00 = • • •7. ....• ..... .... •............,....,,.......,.....,.....,....,,,,,,,,..,......,..,,...,..., ..„ .,. ...,..,....,,,:„ WPPOSTOMINSERTOWSMO,;:ii.WEMI :WIA ::,0:;;A;';',U::: x 25.00 al GAS WATER HEATER ---- k x 10.00 = ie-,-. it G §1::041PSEN7rd00;:**ITTO'•-(040WDES•giniNipi- -` ,j x 1200. us /0). (il; GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 a ...._) A44...:pirtNe.„(gkQUIttr):1ip:::iiii:igi::,i.aigiiio::*im::1;i11;iiiNilliiiiii ;iiiiv, N,_.„---- , x 1.00 In a 62) . BOILER/REFRIG 1-100M BTU ' x 12.00 sts . - ""••••••,,,,,„:::.:::::::: BolaciMEMO.:441450(010Viiii,:iiMili;111;i!:. ,: ipiiiffiemilin . x 20.00 sss . .. SOILER/REFRIG 501-1,000M BTU x 25.00 au soiLERMFAFRIGAM014tI5OMVIrgl ;21::Vi::110man x 35.00 us BOILER/REFRIG +1,750M BTU x 60.00 112 HEAt'POOP:...4ti:AtO•00Nt011f04%::04.104$1111Pagl.ii, x 12.00 is HEAT PUMP a AIR CONDONER 3-15 TONS ./, x 20.00 0 H0T..i:00Mit*AKOMMONOM;301.00:13131:0 x 25.00 a HEAT PUMP &AIR CONDMONER 30-50 TOMB ,..... x 35.00 a HEATPVMP&40100.401TIONV04601.00011M1 , x6000 a VENTILATING FANSx 10.00 a EVAPORATIVE.c0i%ERSI•T:41-45MAK :;•E:IT!ligingii:ifiN x 10.00 = - TYPE I HOOD (PER 12' OR 12' PIN. OF HOOD) x 50.00 = TYPE:.11:H000',::i::•:::.,.::;:i,,:•:. . ii:.: ::.:,:::,. .;::::,:: ::,:i :,,:::.]:,.: ,;*.ii .: ; .:. . x io.00 CLOTHES DRYER x10.00RANGE = x 10.00 = _I GAS LOG . x10.00 = . „ .. . . . • . MISCELLAMQVSINQT, P103aP::ELSEwHERE',:i'•••• :;:l':::::::: x 1,0.00 = ..._ UNLISTED GAS APPLIANCE<400,000 BTU 56100 = ixiNsjgD.GAS:ArTVANC . 40o,pQg BTU _ -i:, .••••:!,;.,;', :i]:,i,si],, ,:bii: .. x100.00 = .... _ USED APPLIANCE<400,000 BTU x 50.00 = USED APPLIANCE>400,000 BTU .-::-:',:-.:::'.:..•y::--1-',"--,1::::-:-i:::::-..',-,-: :.::,,:-- - x100.00 = AIR HANDLER<10,000 CFM x 12.00 = AIR HANDLER'5•10,000 CFM-:: ,:•*l.- •- :H: , ;••'-:::::::.::''.,,::'i:•-•- •:, :•i•• ,,.•...•H... x 15.00 = SUBTOTAL $ *0, ob PLUS: PROCESSING FEE + $ 25.00 NOTE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTAL PERMIT C/91. 0 FEE DUE = $ 1 i SIGNATURE _, ..,„ - imty Division of Buildings