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1993, 05-12 Permit App: 93003428 Mechanical Fixtures Ttri/tLyi?Si9 MECHANICAL PERMIT APPLICATION FORM Ct Information Worksheet JOB STREET ADDRESS: 5 % a 7 11" -cfz-' ' / ` 1 x CITY/STATE/ZIP: o •� c PARCEL NUMBER: *'�~ w . O) OWNER: !? in�ir PHONE NUMBER: 9a 7 ` 79 G Z MAILING ADDRESS: (Street) (City/State) (Tp) CONTRACTOR: LICENSE NUMBER: V v O 6 tiO PHONE NU B R: � � '7> Z MAILING ADDRESS: I 6-1 1 (Street).. (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = :6 0 76. f.�?C{KN}.U:{{K+.•l•:?;:tiY,'{air Yf: '�'. {{C,�;.Y'Yc'{{'+�.:� X 25.00 = GAS WATER HEATER x 10.00 = rM r.{.. ,�• £. x 12.00 GAS EQUIPMENT+100.000 BTU DUCTWORK) x 15.00 = f e '�'}•�>j i�ii:� ;'.': "r}r vS,','`•'2�,2`;k`? ':��:� , �._ :>� ;S jv;. Y' ..r}.4;At {:>;i ;ti{ , ;i :<< . 1.00 = BOILER/REFRIG 1-100M BTU x 12.0b = ... /�!(, .,�,8 1G g8 8 {' •yy�;t�:.,i ;r':? f<4,£5`%i:wt<Fh5.4?"«E = �'f,. S.>:{�. y .'•. <4""+^A `..Ss�b��'�:�:>?«: t% S.Yc*::rSEy`•}4 2Y+,fi'SR2:� cEz? x 20,00 BOILER/REFRIG 501-1,000M BTU x25.00 = ,, Er. _' a a g ` qk f5 a 3 s: . ; ;vnf.t> {? x 35.00 = BOILER/REFRIG+1,750M BTU x 60.00 = i��^pp �,{. . F-�,.; ' F; • x 12.00 = :,,� � R 6 • HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 = m ; 'c``Mn'o}f �� �.��a "�iZ��� .�, Mt.,.,�.�n ,����.��; :�;��}�_.i x25.00 = HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = .'•. ; 2M; 6 NKc� WOM;' `' raa = VENTILATING FANS• x 10.00 = Y9 � '{Jy5't2f;`}y`:;;ty{;.�,'?.::j5.;�(y;{2• ? .,.?{{�^f}Y PM* o o , . � ' m� ;'<:.:�.:{ �: .� ,. �. € � x 10.00 TYPE I HOOD(PER 12' OR 12' PTN.OF HOOD) x 50.00 = f .ua"l� hk{#..>`s{ .,w}?.c tit}'•:c S n "✓`,''.iv, XC�22ktiC,.., d'4vx x 10.00 = CLOTHES DRYER x 10.00 = /&.'cam ,<',S''6.'d,"� 5 t. •�{S <i: �:r%:;rS`+,.{': iii?:, ,�.�, ..z.; � 00. 10 x .:r :Yue,. `?^,��?a,.?&�.. ..,..�r'w{.f�s{z<...,.,... .�i'sr�3:�r's�'z�.......�..�;u�v��'.•,{�4:�;:.. .? /O Cts O GAS LOG x 10.00 = . .. .WA,Ltek;OP: :Nr ;,}n} x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ®.. t.0 e,:CO ` x100.00= USED APPLIANCE<400,000 BTU x 50.00 = P:5 .• °•" „('• €" `.:g a Q s'u • `'r 1 x100.00= .ta..c,M..«.... -�s. Ns9.44, fi ti� cx i. m� AIR HANDLER<10,000 CFM x 12.00 = ��x'W�N� 1' lfiY}f!fS )5 { �c2 ,.aJ1: i�fail aw•,.LEla ., 0.A:B�A• :;A,` a{({. 4,4 : T x 15.00 = SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT L FEE DUE =$ /7 SIGNATURE