1993, 04-13 Permit App: 93002451 Mechanical Fixtures-
147
v SitW: $A1I AL r 1 lwrutaissms MIMS
Information Worksheet
JOS STREET ADDRESS: pi/Z)`7
. S�
CITY/STATE/ZIP. o%u j2e L c% 9-/C, PARCEL :
pH0fl EMBER: % - % % //
OWNER:
MAILING ADDRESS:SG�l7Y111
(Street)
(City/State) (Zip)
CONTRACTOR: f3 A-l-ao ►m s G- *-Ar.L.17.c.LICENSE NUMBER: g A-"--" L-,4 1'0 t Z__
PHONE NUMBER: qZ z - '5,1 0 c,
MAILING ADDRESS: a Newl, ge eit4 3•1c-••t•.a.\A.* c 2.04,
(Street) (Ci ,y/State) (Zip)
MECHANICAL WORKSHEET/FEE SCMEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
0-3 TONS
3-15 TONS _
15-30 TONS _
30-50 TONS _
+50 TONS
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP 6 AIR CONDITIONER
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
i
3
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 4.00 =
x 1.00 =
x 12.00 =
x 20.00
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00- _
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
X100.00 =
x 12.00 =
x 15.00 =
0
/cm?,od
/en ,0-c
NOTE:
SIGKATURS
$35.00
SUBTOTAL
$37.
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
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