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1992, 03-03 Permit App: 92001216 Gas Log, Piping,g"5 .. ECHANICAL PERMIT APPLICATION FORM .. ac)\e Q Information Worksheet JOB STREET ADDRESS: )J f / 07 S .)-- • C -a CITY/STATE/ZIP: VJA ooka k , ggb3 7 PARCEL NUMBER: OWNER: 1r) CS 4 wr1 IYIs-Fr PHONE NUMBER: ga'cP - .760 MAILING ADDRESS: F-4 (Street) (City/State).- r� CONTRACTOR: r 4 ) CI\ C 42Dr_�'�J CEtiliF�2 LICENSE NUMBER: t- ►4ICA &C, I -73 I lel PHONE NUMBER: (SOq) gdto-S'91 I MAILING ADDRESS: E • q31 D Spi;'A9LCe S. I`A,.ie_ LJA 992 Deo (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER :GAs Qt1lPMENT<1DQ,000.5TlJ. -. t4 tuDES mn.q..v..v..ww,.awr:..:.v. r. evw.w.wwivrxN. aw.vwiv3r. rw. GAS EQUIPMENT+100,000 BTU DUCTWORK) t.+.,........n..........w.�.a: �...............w.,.^M^...^^..�w...i..,.w..,,..,.^,...+�..a ..w...m;.a>+.-y:rc ....:......!;fie..-r..•..v,.. BOILER/REFRIG .1-100M p„ BOILER/REFRIG 501-1,000M BTU '751± r-,.....: -180 ,RtaktVW BOILER/REFRIG .+1,750M BTUK'w< SEA- ' ' MP ;AIA CONd t3NE#3'0--'C. �ttSw a3~':. ir j. HEAT PUMP & AIR CONDITIONER 3-15 TONS ... � SEA- <=PUM.tROON[ ;ION 111TAIS> ,K� 11-0. HEAT PUMP &AIR CONDITIONER 30--50 UR ONO VENTILATING FANS .ter.._ TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) ...r.ww..va..wy vw.,•�:.�nawrr::rra.::•.vl::n}:.v.+:.vrr::::.v..vwM.^:-:.vp-::: CLOTHES DRYER -' GAS LOG MISCELLANEOUS (NOT.COVERED ELSEWHERE: UNLISTED GAS APPLIANCE <400,000 BTU ULINS ED T _ GAS.APPLtANCE>400,000 USED APPLIANCE <400,000 BTU USED APPLIANCE x400,000: BTU AIR HANDLER <10,000 CFM AIR iANDLER>10,000 CFM` NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x25.00= x 10.00 x12.00 =- X 15.00 =§ _ - x 12.00 = . _ r -. - - . __. _ >. _,Z. 1: f7-; ;.::-.7"' . .1.'' x 2a oo : - ;x25.00',,::=.K,;'•rr:....� X35 00,=:�r zfti� r.-7 x 6000 x 12.00 X 20.00 :, x 25.00,.,:.= x 35.00 Y: r �4- . 7Z-'":.::--.:4::-...'7.-----.:,--,:'•!.. . �T.r.x: �'sYwt.Cc�? -..z' -f--, __ Y mc ry .. .Z-.exn ,ri Zi< - tr. _. ; .�1-7,-,Z7.• ,..� 1:+*.4 s_ - '" +T ' '- l - .. ,F nsntA e ". _ . x 60.00 X 10.00:=7: x10.00 =.. 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 = rf^ 41 ; ' -.: _ .. .::t:..�_ - _•.- -..-= /0112-2 , - x 12.00 = X 15.00 = SUBTOTAL $ / / Op PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE ov =5 3(0 '-