1993, 03-18 Permit App: 93001587 Mechanical Fixtures fcc.,..c AdA
Ifit $ l iw.
Inforaatiaa Worksheet Le e 1
Jos STREET ADDRESS: Z, a GJ a V e,2 c/e . ,5/4) GI,/a . q 9 2/
td-1 . 99 a/ PARCEL NUMBER: D_`h v O (.0
CITY/STl►TE/ZIP: �
OWNER: / -e /7 Gam; /// -ms Phis NU BER= � - lv < �
MAILING ADDRESS: c)
(Street) (City/State) (Zip)
CONTRACTOR: Q �+t-aoLICENSE NUMBER: R -+,e-i t4.-14 t t 0 It Z.._
PHONE NUMBER: qZ't.. . .5-4 .0 c,
MAILING ADDRESS: ( t\9 U. vv,, s c iTait 4 3 .-..t,1/4/ws c zo,6
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER / x 10.00 = _ /p ,o0
HEATING EQUIPMENT <100,000 BTU / x 12.00 = / , ob
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) c:. x 4.00 = _ c2 .00
GAS PIPING (5 OR MORE. EACH: ) x 1.00 = _
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00 = _
REFRIG 101-500M BTU x 20.00 =
REFRIG 501-1,000M BTU x 25.00 =
REFRIG 1,001-1,750M BTU x 35.00 = _
REFRIG +1,750M BTU x 60.00 = _
HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ x 12.00 = _
HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20.00 = _
HEAT PUMP & AIR CONDITIONER 15-30 TONS _ x 25.00 =
HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35.00 =
HEAT PUMP & AIR CONDITIONER +50 TONS _ _ x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE COOLERS x 10.00 = _-
TYPE I HOOD (PER 12 ' OR 12' PTN. OF HOOD! __ X 50. 00 =
TYPE II HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE x 10.00 =
GAS LOG X 10.00 = _
MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ X 10.00 = _
UNLISTED GAS APPLIANCE <400,000 BTU _ _ x 50.00 = _
UNLISTED GAS APPLIANCE >400,000 BTU _ _ x100.00 = _
USED APPLIANCE <400,000 BTU x 50.00 = _
USED APPLIANCE >400,000 BTU x100.00 =
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER >10,000 CFM x 15.00 = _
SUBTOTAL $ o�
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL FOE DUE
s PERMIT $ (79 )
$0?s: s.07 1
SIGNATURE `f }' a -