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1994, 01-26 Permit App: 94000616 Water Heater, PipingJOB STREET ADDRESS: C1TY/STATEJZIP: OWNER: MAILING ADDRESS: (Street) MECHANICAL PERMIT APPLICATION FORM information Worksheet (-1 CONTRACTOR: MAILING ADDRESS* k /a (Street) (CitylSta MECHANICAL WORKSHEET/FEE SCHEDULE PARCEL NUMBER: PHONE NUMBER:,',49,57- :(Cily/State) (Zip) LICENSE NUMBER: Al4x..criilita26._ / 1/ PHONE NUMBER:22,. DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODOVyNOVINK7 GAS WATER HEATER P4Aig0410.100WWORSKOTO10.004,45::g$1:iii::i!!:"! GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU. BOILOVRE#000:110 BOILER/REFR1G 501-1,000M BTU 4 BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR cONDmOt4ER 0-4 TONSHEAT PUMP & AIR CONDITIONER 3-15 TONS ;AT PUP AIR CONDfl lONER 17777: HEAT PUMP & AIR CONDITIONER 36-50 TONS TONS VENTILATING FANS TYPE! HOOD (PER 12OR 12' PTN. OF HOOD) TYPE HOOD. CLOTHES DRYER RANGE • • • GAS LOG :.ISCELLPEOrJS (NOT cOVEED ELSEWHERE UNLISTED GAS APPLIANCE <4C0,000 BTU ULINSTED:GAS 'PL!ANC >4C0,000 BTU USED APPLIANCE <400,000 BTU A!Pi HANDLER <10,000 CFM AIR HANLLEH >10,000,CFM•0: NOTE: MINIMUM PERMIT FEE iS $35.00 (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 az x25.00 11 x 10. 00 x 12.00 62 x 15.00 62 x1.00 x 12.00 = x20.00 = x 25.00 = x35.00 = x 60.00 = x 12.00 =F x20.00 = x 25.00 = x35.00 = x 60.00 = x10.00 = x 10.00 = x50.00 = x10.00 == x10.00 = x10.�0 = x10.00 = x 1,0:00 x50.00 = x100.00 x50.00 = x100.00 = x 12.00 = x 15.00 =- X . SUBTOTAL //, 0 0 25.00 PLUS: PROCESSING FEE EQUALS: TOTAL FEE PERMIT DUE - -3 G•00 SIGNATURE 3 - J\1) county Division of Buildings