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1991, 11-20 Permit App: 91008038 Pellet Stove MECHANICAL PERI ;:---'PLICATION FORM 91, 8038 Informat on Worksheet - Si 40 JOB STREETALE: ESS: (luck-Nb. WOW CITY/STATE/ZIP: - PARCEL NUMBER: OWNER: ` PHONE NUMBER: MAILING ADDRESS: r (Street) (City/State) (LP) CONTRACTOR: r I'} ICO &KF(ebi✓iJ CEIJI-Eke LICENSE NUMBER: rW-ICO&C I-73 DLA - PHONE NUMBER: (.SOq) qo2(o-?9/I MAILING ADDRESS: E • q 3 I D -SP 2A3L Q, .pOK-AA J e- LJ tq 99 2 of (Street) (City/State) (Tp) • MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH '' - DESCRIPTION -. - - _ OF UNITS UNIT ' =AMOUNT - , ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) - x 10.00 .'':2�'~ ::h_C:-{::->?2'+r`i - -•SII-):{:-:...: - - IN :,,` _ ,r, �@�� F/ 5 �,� :� ...:- .. .:,.;:-:=:.. x 25.00 GAS WATER HEATER �� ��' e::<u„yuvviwwvmauuv:rx:Vin•:yf f w,v.Nf � H +^-•++••YY h •• .. X 1 0.00 V :GAS arti3MEI T7�Q00-t ` Urat lfftrB~ ..v:- :.- x 12.00 = - :> .� - f GAS EQUIPMENT+100,000 BTU DUCTWORK)'=':'> - -- x 15.00 —,-, �` :• .. s xG: . -P! :G OUTkEB .. ,;?z> :r-:_ x 1.00 Y= ''r^r.'_ =xF .>4." :7_ -BOILER/REFRIG.1-100M BTU. = 'h ;s-'H `Y - - .. • x 12.00 .1",.. -_-- 2-)-._;.t.1.1.4.4-0,-,:-•%:' ` ...r :e.f�:RS.rd.�����. .•'• � .'. �. � � �- � ,x2.0-°9-',7i=7: 0 00, ;� d "4-:4-f L .�V 3�.�.+t wF• ��rt r_.q� '. BOILER/REFRIG 501 1,000M BTU = -= --- .x25.00 `7..r .$- .=: 'BE, RI : t �� ; x 35.00 -� . ; , I -; BOILER/REFRIG+1,750M BTU r'' " ' "' x 60.00 -,r4:71)._,,,,5- - - +N C t71‘::.-,..„.,-_,:.:_,..7,,,,.....r • Y1N.1.! •- .. 1 BONDi - ONE# O. S iUl . 4 ,•!..1_;01:714,- .- --- - {` HEAtPUMP&AIR CONDmONER3-15 TONS - 'x'20.00: 'c; �`• € 2z.=-� i .• ., , ;: : -t 'a sr 1-.CO"0 1, .4 r_ TO ,,` :-4: ; +f,�.. =as F• 4. x 25.00, 4: `,�.: 3&4w `� . +s' [41, HEAT PUMP:I AIR CONDITIONER30-50 TONS -- •x 35:00 ,, ,. ,.,� .�' .' '< .: ' ' '� *.s •` r'a?"k ''2'jr '..: ``�'- -- x 60.00 - ..`�."ry 9' '1' ''11Si- X' tVENTILATING FANS-�; - -•_ fn� Yom' .'! + tr.s. ;r.....U.-.acrmrtic - x 10. 0? y> La '^XraJ �--\y-•,,,, n v 1t t: f .v�c.VP.�3. .- 1�E�t�-�Ot, 3. :. - ..-- ,. ..:�•->�> ..�: �,:: x 70.00 :t K.-. _ �. f�.-. �,,s,' :TYPE I HOOD(PER 12' OR 12' PTN.OF HOOD)7..r.7..:';-7,-",;z:. x 50.00 —. - ..--,";.:•:::;"•;-1-7--7";:: • -i ' ,,k'',,, r •.,-..^. :^:.,.,-,.•;y-.'•y; :^>:��c_ rs:;r.:"'r:;,-`�rop�'"nxN;;nt�..>;;..�,;Yr��:�...».a.r:: - �y '. {� p. .• . 7::-:Y:::S::.::4-; >:-•'-?;:}----�--_--yn>.- u-:M:yy\S:-?.::n-- e - - -.. x 10-00 --;••1'-'""-1-'::7:-:.1, .'S nz,. -* iPOGiI .:H w ....�.<...�.r:,.•... > ;Cnc..�oo .Hu;�}�dU ,) :�,,,aow..,.r._ F: a�: C• LOTHES DRYER •., °t,. x 10.00 = - •- r,y-�.n+. <w - a-m do-±-?t rc.- - x• ryecy wr„. y..w,.w.n)+ . :u.; • a -••-,- .- G y3 ? 0.00 t "F i';11t1.is.nr'.r:mow.-w--. . l S�.,w v-,kb-�L+✓-wu'.,...:-:.__,x_ ...G?..u.,... x 1 _ ... _ .- GAS LOG> w f x 10.00 = MISCEL1ANEOUS(NOTOO EREQ ELSEWHERE '`51 x 10.00 = ' UNUSTED GAS APPLIANCE<400,000 BTU - x 50.00 = ULINSTED GAS APPUANCE>400000 BTU< - _::': x100.00 USED APPLIANCE<400,000 BTU x 50.00 = USERAPpUANCEa40n,obO BTU x100.00= AIR HANDLER<10,000 CFM P a r X 12.00 = AIR HANDLER 1O 000 CFM `>: x 1 = 500 t (i /' ; ft1 , SUBTOTAL $ • _• _ OUs,..,,.„,n6 & SAFETY:PLUS: PROCESSING FEE +$ 25.00 NOTE MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE =$. ) SIGNATURE Spokar= T. -`