1993, 05-17 Permit App: 93003629 Mechanical Fixtures.
JOB STREET ADORBSs•
CITY/STATE/ZIP:
Mt1i:::Al4ML now arniaimasa rums .
jntoraiti S Worksheet
OWNER:
!MAILING ADDRESS:
(Street)
CONTRACTOR: f3 41111:' t MG +- M.. -=0,4g. LICENSE NUMBER: R t t Q L. -
PHONE I1UXBER : ck L"+._ . 71,0 c�
MAILING ADDRESS: "sr sr. (C1LY/State) (Zip)
C
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
O�ERITS XUEICH
PARCEL NUMBER:
PHONE NUMBER:
^`zS�Z'3
(City/State) (Zip)
DESCRIPTION
= AMOUNT
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
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' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
0-3 TONS _ _
3-15 TONS _
15-30 TONS _
30-50 TONS _
+50 TONS _ _
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)_
UNLISTED GAS APPLIANCE <400,000 BTO _
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
MEM
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
1
MOTS: Mirzyam) �C :9::. $3S. 00
SIGNATURE
SUBTOTAL
$
EQUALS: TOTAL
PLUS: PROCESSING FEE + $ 25.00
• PERMIT
FEE DUB • $
clq
144004. sled Safety__