1989, 11-20 Permit App: 89004837 Water Heater, Piping .
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MECHANICAL PERMIT APPLICATION FORM -C ' '
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Information Worksheet �e �`
JOB STREET ADDRESS: 1-0,00"4 -� 00 W 4.A n
CITY/STATE/ZIP: - (AINAr PARCEL NUMBER:
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OWNER:` -.�•- 0. - PHONE NUMBER: CI 2Ci •C( 3 3 C
MAILING ADDRESS: S `4 z....^ N - ► ---0X
(Street) (City/State) Zip
CONTRACTOR: t _LICENSE NUMBER: q3 ftte-TJ ithgrAtte (3 a
PHONE NUMBER: a! 2_2,_-nrv-v
MAILING ADDRESS: (=.- L1--8 d 2 w•-e+... 154' ��$-
(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 = /0 ce...,..,
s HEATING EQUIPMENT <100,000 BTU x 12.00 =
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) L x 4.00 = L-{
GAS PIING (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 =
1 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 =
RANGEx 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 $ / `t1 c.
PLUS: PROCESSING FEE + $ 25. 00
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EQUALS: TOTAL PERMIT
NOTE: NI IMUM PERM FEE :07.00 FEE DUE = $ 3i, 4'°
SIGNATURE ► ,