1989, 08-28 Permit App: 89003055 Pellet StoveINFORMATION WORKSHEET
PARCEL NUMBER:
STREET ADDRESS: CO• : 77/
CITY/STATE/ZIP: 4-/
SUBDIVISION:
BLOCK:
LOT AREA:
OF BUILDINGS:
F/A:
ZONE:.. ,. DISTRICT:
WIDTH:
OF DWELLINGS:
DEPTH :
R/W:
WATER DISTRICT:
C.):47; ER :�� �`1� �%'-� PHONE: .50(��a
NIAILING ADDRESS:
41 TY/STATE/ZIP:
.:ONTACT:
SETBACKS: - FRONT:
1.1:M1T USE:
PHONE:
LEFT: RIGHT: REAR:
=z
r e s f a! f h f 1 s a s s e s! 1t i 1 f xxZR tAh*!t!!ttR** h111**********************************,
BUILDING INFORMATION
):y':'}thCPOR L I CENSE NUMBER :
'ON TRACI
I r.1 NG /.I)1)RES.
,RC,ii I TI- CT/I+?UGI14EE:R:
Ohl Li 1IG ADDRESS:
NEW:
PHOUE :
UII.DING DIM I-24SIONS:
?EQUIItED I•1J ZING:
X
(WI DTII X DI:Y'1Ti) SQ. FT.:
# HANDICAP:' SEWER (Y/2l) :
>�� 'ty/e ./
1 YYDRANT:
C )F- LIC
Co iRACIOR:
NAILING ADDRESS:
*:::::**:::****:::***t**************:*:**::***********:*************
CONTRACTOR LIC#:
CONTRACTOR:
MECHANICAL INFORMATION
e /2e,PEN_______46-Nmey - •
'�T,II.ING ADDRESS:
SAP•fpie SAA'9314c" 4): ___?7;t6tt.
',F.Cl'KIC: GAS: OIL: CCAL: WOOD: / SOLAR: HEAT PUMP
ERGY CODE: WSEC: NI EC:
UTILITY: SGC:
J•.. PROACii - PRESCRIPTIVE: POINT: COMPONENT: SYSTEMS :
,-:*::::*::*::::::******:***,:::*:**x:::*::::::::****:::::::*:*::*t::*:t
MECHANICAL FEES
_'1 ::1NG I.1:E
•.;.)1'J. :;Y_,Ti .M
-7Y1'ER HEATER
}i•i'i; }:QU1P( 100,0C.0)I;i-t1
};(jUT P 4100,000
PIPING - t OF Ui: 1TS
';'i 'U } : P 1-100 } 3'1'U
';'PUMP 101-500 1-70
':'PUMP 51:1-1000 P70
•i';'UMI' 1001-1750 P7U
'i•i'HU:P 41751 }PTU
1--100 }i111
101-500 }illi
501-100 I : i'U
;<IG 101-1750 P10
i1G 41750 IC1'0
C:);1)1 TI c N ER 0-3 HP
C 7':;)1'1'I (.7!;ER 3-15 HP
CV,:; )IT1G::1:R 15-30 HP
c:77):01TTU:I: Z 30-50 HP
C ,';1)) TJC' rR 150 PP
P1,'i'ING FANS
:,'} I VE COOL}
1-1 0 - 0
NUMBER OF
YES OR NO
x
PLUMBING FEES
ITEM DESCRIPTION
PRCESSI NG FEE
'IVI LETS
SINKS
::'ci Jri ERS
1; ;iii TUBS
K I i'CI i 1:N SI NKS
I)1 SIi►+'lti`:1;ERS
G J P,?GE I)I Siti):IAL
CTJY1'IiES '-1,1;11ER
tr;'I P1'1'Y S1 N}:S
HI.I:C'1';iIC tiAI?:R IHI_ATERS
F11. -.)DR DRAT NS
1.1I -)7R .511:1:S
}�?.I'. S11:KS
;' "►")F
DTZ1-.1 NS
SI'KIN}:LER
;;P" -:/.GE EJECTOR
‘•:I -TKR 5✓JH'I'I?:i'R
IIi:I1:l.I,
I):I1:}_TNG FOUNTAIN
NUMBER OF
YES OR NO