HomeMy WebLinkAbout1992, 08-19 Permit App: 92006636 Insert MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: , 1. opa. o. pc) Lel., (,(.-
CITY/STATE/ZIP: €v n ,i_t i ('C!D)(o PARCEL NUMBER:
OWNER: e0,2— PHONE NUMBER: c1 a•(o -CoCp 3�
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: F"t'} )C.z) C (? E-1.11-Fg LICENSE NUMBER: F►4I CO &C i-73 b 1A
PHONE NUMBER: (.50(4) -A' 11
MAILING ADDRESS: E • q31 D .3pA9ue .Spot AAie_ LvA 992 Deo
(Street) (City/State) (Zip)
_- MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
>WO� OEIIA..I =.
.-----. .:.. x25.00 =
aS,C�
4::::.: ..................:........... .......................................:......i::iii{Lvf:-:i:r::::::..ii':v:-:y.:v{:i v.: _ ..
GAS WATER HEATER x 10.00 =
A
g S ggli 'MENT<iOPMAII INPOO.0S :::;: :><>>::: x 1200 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00
GAS P.INGAxQ.UT . V: . 1.00
=
BOILER/REFRIG 1-100M BTU • - • x 12.00 -
'gQi . g- IGt MAam,aT�,,, :w w vycwc.Mft 20-00
BOILER/REFRIG 501-1,000M BTU--;
x25.00
'BO1LE EFRIG 1,0001- Ais CTh r r.. c y x on - :. x 35.00 .s iai-n 3 ,,•t.�;� r
i::.nn.f rr z: .. ....�...+,::;Ct . r.,:::_-.,:ska..E:wwN:.,�� ,w..,. w,:�cwrw.w:.•.3�.,a,cnF,..wsr � 4 ;•_
BOILER/REFRIG+1,750M BTU ~ , x 60.00 =
F, ,ter. :.x�: � �..�.r:
iT VPIN P AI Cc Nb rf(ifi glifi NS.:}.._ I x
• HEAT PUMP&AIR CONDITIONER 3-15 TONS - x 20.00 -f
:AIC lt3 R�1 �30TNS `i>`__:>_::« x25.00
HEATPU .,:$c<� OND � NE •---�----���>
HEAT PUMP&AIR CONDITIONER 30-50 TONS. . x 35.00 _`
f E1 I UMP&t IR COND hOI ;,t5i)'Tfl >_E r::I x 60.00 _.. •
• VENTILATING FANS_____ �, x 10.00 =
VAI' « V�1V1= LER :.. x 10.00 =,,.:.c.�»w..co..::.,...:::.Y.,..r..:rx::..•:.:.::::.:::,::::::-.....,.•..•.:r..•5:::....::,.....a5. ...?u.,K,�...a r .: a s
- TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD
CLOTHES DRYER x 10.00 =
,�-A.:-.:Y.::.>':.;.:>:y::}-:::.::ter:-.:::ri:�:��-:�>r:<•>?:i::::-:c-:'::•;;:r;:->::i}::::r?::.:t;.xk+`7r::�:rcis4�tfir:;•:�:•::•Y.U•::citii?::C::•::�
GASLOG::.....................................................------....--=--- - - ----------�-�-----------�--- x 10.00 =
MISCELLANEOUS(NOT COVERED ELSEWHERE x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED GAS APPLIANCE>400,000 BTU >.ig `>'' -_-..-.; x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>400`000:BTU.. x1 =
00.00
AIR HANDLER<10,000 CFM x 12.00 =
Ai
HAND
R 0
x 15.00
SUBTOTAL $ 02,506
-PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT oo
FEE DUE =$ -oO
SIGNATURE
'; ane County Division of Bui`d nas