1991, 04-09 Permit App: 91001697 Mechanical Fixtures ,, , WitterwnibML rcnirut ura b1 u Iuw runty'
Information Worksheet
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CITY/FTATF�/ZIPS, �.- PAR NUMBER: ,
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MAILING ADQRESS s p .;S3 c, c #2 _s Act/
(Street) t (City/State) (Zip) F
CONTRACTOR: g1--Ar14....&1,...- LICENSE NUMBER:
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PHONE NUMBER: 2-2_ -V)-•-•
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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 t x 10.00 = L U -
HEATING EQUIPMENT <100,000 BTU l x 12.00 = d4,1."a..
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4.00 =
GAS PIVING (5 OR MORE. EACH: ) 2 x 1.00 = 7Z_446iL
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.Q0 =
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 = µ`
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 =
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''. SUBTOTAL - -. , ._. _ 2`+
w T a ' PIM: PROCESSING FEE<+ $ 25.00 :
i1- "". '''''''*4 5,: ; EQUA ,S: ;.TOTAL PERMIT, t - 1.
t , NOTE; , T PEE 11 535.OQ =- -,., : ' ,,,...-FEE DUB $
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