1989, 10-09 Permit App: 89003871 WoodstoveMECHANICAL PERMIT AP -PLICATION FORM
( Information Worksheet
JOB STREET ADDRESS: S. /0/s- 3 . L /fie( .
CITY/STATE/ZIP: UALA.J-c u% 4A 990 37 PARCEL NUMBER:
OWNER: ,L -Oro- 144-t4' a 4-41
MAILING ADDRESS:
PHONE NUMBER:
(Street)
CONTRACTOR: ice R14T CA fx, /41 +-
MAILING ADDRESS:L.'22�8 Niai)-4-1'0'J
(Street)
(City/State) (Zip)
LICENSE NUMBER: 140 /WS /gb h1 G
PHONE NUMBER: 48.3-A17
4•01c4-e•A,(4A- 99.207
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER
OF UNITS
DESCRIPTION
X EACH
UNIT
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 & AIR CONDITIONER
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12'
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS' LOG
PTN. OF HOOD)
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
)
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 =
= AMOUNT
1
�5 cr'
NOTE:, MINIMUM PERMIT, FEE IS $35.00
SIGNATURE
SUBTOTAL
$ 2- 0O
PLUS: PROCESSING FEE
+ S 25.00
EQUALS: TOTAL PERMIT
FEE DUE
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