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1992, 02-25 Permit App: 92001040 Gas Log, Piping cr@ ,�p cTca>�t� "?1 ,.:_CHANICAL PERMIT APPLICATION FORM v(b qU v l l r6 Information Worksheet �j JOB STREET ADDRESS: f_ , ) aL0 0 S W Gu-g,.- 57, S CITY/STATE/ZIP: t)C ) vl-�. arq / b PARCEL NUMBER: OWNER: 18-Q..\--t1 \A)&I S k PHONE NUMBER: 61c22- 34/3 MAILING ADDRESS: -3 . (Street) (City/State).- (Zip) CONTRACTOR: F4 )CX C 4 t?c iJ J 1 F✓t LICENSE NUMBER: �►4I G0&C.I-73 D Lk PHONE NUMBER: (SDq) go?Co- . J I MAILING ADDRESS: E • 1310 .5-pA3U € Soc�a,ve_ ioA 9920 o (Street) (City/State) (gyp) __ MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH ' DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = ,- WOC# :OV IN : : . .. - x 25.00 = .-,- a,vwr,h--uwvv..ww,i4rauawvieww:.vwii:A{+w Ye>M b.W.r ii.L]Mv.:Utin56:..w.v 3> H { +C-1:. '.- GAS GAS WATER HEATER':-.-.. ..., y,,.. :_>. , -- - -- .--- -- x 10.00 - - r x 12.00 -_ - - N per,, :E??,: .n:: .::.,. `.GAS E41ME <1O,tSO4S GLS aw N k ' GAS EOUIPMENT4100,004 BTU DUCTWORK) -. - -- x 15.00 R_. `` ° ." x- - - s E � S-t, � nnJw�v..nvr.+uS J � 4 . BOILER/REFRIG 11 100M BTU : x 12.00 : - ' :' "` .Tt "'. }r�... �� ,4 � "tea. '4►+...:-:�.G��3 ',�. tv r: >.:v.,'3maS Liu�ii�� 4 1..._. x 2.0.007_,;:t.71- - ��rfil\�6'.afe -, BOILER/REFRIG 501-1,000M BTU_ � � r= . =• -'_ i,: . . x - -.- . .q, :.-�4 t • '� i=• .-... x z5.ao 13a : r fiC 1100: '::1�-.- OMB 1 L3 ,{{v= �. _ x 35.08 ; .i--4,>� .,,.r 4 - t` BOILER/REFRIG+1,750M BTUK``'-.- r" =-f '` - r-•-. x 60 00 r m -. .. ��p$c�A1F�.CONtS) ONE#3.1�3"1'flNS ,{> ..c., --x12.00 ,.", j}a.c_ ,,, r,,.s�,}.. �..-. .. '� HEAT PUMP&AIR CONDITIONER 3-15 TONS= --"` x 20.00-.'-;:-'1'.-- = .- -..- 1 71:775,;:".1.7.::::;77.i:, EA r fitp 9 ER. : K .. - .x 25.00 �, r�--4� 'r` ..- r �� :At �D 3 N t1�`>. �3(i.Tt)NS? , r� x Y . '- . HEAT PUMP&`'AIR CONDmONER 30-50 TONS'- == = - -x 35.0e,7::::!;:: - has-:7�• ' r F .� e /.1F3 OON a T(QN �'+SO1TONS-.�, ti 4,, : ._ x 60.00 . - . . =. f • VENTILATING FANS ` . :'-'.' . :_ -ry- :. _ . x 10.00 - ..f....�. X ` - 4 • . .. .........�.w«7focaw . ..s.,�daow..�.:::awa`•x{d.,.. Mr.,.,:::. �. ' . _=•�r • f' TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) ' . x 50.00 - x 10.00 = • - - TYPJ=�f-1.100 -- , �� CLOTHES DRYER -• - x 10.00 = 1 x 0.00 GAS LOG - I x 10.00 = /Doo MISCELLANEOUS(NOT COVERED ELSEWHERE . x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GAS APPUANCE;>400,000 BTU x100.00= USED APPLIANCE<400,000 BTU x 50.00 = USED APPLIANCE'>400,00gBTCt ,. .. : - x100.00= AIR HANDLER<10,000 CFM x 12.00 = AIR HANDLER>10,000 CFM;; ._ : x 15.00 = `-- SUBTOTAL $ '/ °� - PLUS: PROCESSING FEE 1 + $ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMITD-o FEE = $ 'Lv . 1 SIGNATURE