1989, 10-18 Permit App: 89004141 Pellet StoveI NFi)i J'J TI ON WORKSHEET
PARCEL N JMBER:
STREET ADDRESS: N [7/S t Jam
CITY/STATE/ZIP: "ft--stAu-12) Wo o
SUBDIVISION:
BLOCK: LOT: ZONE: DISTRICT:
LOT ARF.A: F/A: WIDTH: DEPTH: R/W:
OF BUILDINGS:
•
€ OF DWELLINGS: WATER DISTRICT:
ONER: �i7��Q a -O gLtO
V.AILING ADDRESS: r4W
CITY/STATE/ZIP:
CON'T'ACT:
SETI:ACKS: - F':?U!:'T: LEFT: RIGHT:
i:M1'f U:;I::
PRONE: - (p(sc)
PRONE:
f f t t f f f t f f t t f s f f t t t t t t t t t t t.f X f. X X Y f X 2 X t f X X Y Y f X X* Y X* X Y X* X t t
BUT LDING Ii:FORMAT I ON
�'..tZ/Citi: 1.ICi'.N ,E NUMBER:
PHONE:
(',),I 1.3 1:G I.I.0iii•'i::,f;
),, ('iiI'1'ECT/ENGINEER:
t;7.1I.I14G AI)i)RE`::::
I' "EF.L UN :
G:CUP7,1rr /WM:
! JILDIN:G InP.}:? ;Io' :
x
z1O::E:
TION: CIiLNGE OF USE:
BUILDING GT: STORIES
(I:IDI'Fi ?: I)Ej 1' SQ. FT-:
i-;;jJI1 .1) I'M Y1 ?G/ f 1iLNDICAP: SEWER (Y/IS) :
%°,41,ade) Jae.xed}
Di2A1:T • _
curl -Rix -10R:
MAILING ADDRFSS :
MECHANICAL INFORMATION
CONTRACTOR LIC# : Ledge./
/ 7JZ'h
FI94 CD egpe v . e6W7,,- ' (6 . .: .
£ .9,vid s,tatf ful� � seevi,9#6,9 99
CONTRACTOR:
I:AILING ADDRESS:
ELECTRIC: GAS: OIL:
ENERGY CODE: WSEC:
CCAL : WOOD; % SOLAR : HEAT PUMP
a p.
2•Iir'EC :
1d'PROACH - PRESCRIPTIVE:
UTILITY:
SGC:
POINT: COMPONENT: SYSTEMS :
7 7 1 t l t l t t l t t t t i t t t i i i t f i t! i t t t* 1 1 2 t ! I t t t t t X t l t t t i t t t t t t i t i t i t t t i t i t t t t
I1ECI LAN I CAL FEES
M DESCRIPTION
F:S.SING FEE
SYTEM
)`;'i JVE/I!:_;}-:itT
WKI'ER IIRAT ER
liTG I:OUI P ( 100,000 )Ih'FU
}iTG EQUI I' +100,000
PI PI NG - OF Ute 1 T
i UMP 1-100 BTU
:'UMP 101-500
:PJPiP 501 -1000 ICPU
..1-P MP 1001-1750 NTU
'1."I'JI•;P 41751 IiTU
1.:1G 1--100 I3'i'U
i? I G 101-500 13111
LIG 501-100 I3'1'U
ii7G 101-1750 I3TU
-+1750 IYrU
CONDI! TIC' ER 0-3 HP
CONDI T1ONER 3-15 HP
("c,::I)I2'IG:}:R 15-30 HP
Ci.,::1)1TIG::ER 30-50 HP
C: ,NDI 1'IG:: - R 450 HP
1 J
LAW I:G FATS
COOLEi<S
::
.1►:;
: r -:r) C;7'; APPJ,T
NUMBER OF
YES OR NO
PLUMBING FEES
ITEM DESCRIPTION NUMBER OF
PROCESSING FEE YES OR NO
'J0I LETS
SI N KS
>ii•Y ERS
P','i'i i 'I "OBS
KITI:}i}E:N :;1!:i;S
1)1 `.'.rh'/
G1.I;i;1tG}: I)I Siff):.1 L — -_
CIL/1'i11:S E;L`;IuER
tri'I LI '1'Y SINKS
1:r,Ec'1'i<IC 4:1.'I'}:I? H}-Jt'I'ERS - -
}'i /"SDR DRAT NS -
I'IL)D SII:I'.S - —
PAR `;II:}:S -
}'J")'r I);J,1 !2S
I_'r'U 5I'RII:}:LEIZ —
I-rt1�GE Y1EL1'OR
U}:ILIJ
DRINKING