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1992, 07-29 Permit App: 92005831 Gas Log, Piping 52_. 5331 MECHANICAL PERMIT APPLICATION FORM i Information Worksheet C-OS° 1 JOB STREET ADDRESS: E• / a DO(© '4A CITY/STATE/ZIP: DK64rw 1 Loa. ?9d.O(0 PARCEL NUMBER: OWNER: LT CAL- C-f c)2I2�.f PHONE NUMBER: q a 1 - MAILING ADDRESS: SA-yv' (Street) (City/State) (Zip) CONTRACTOR: FPI- I CU C 4rziE.iJ CE,JI.E.g LICENSE NUMBER: r14ICO CSC 1-73 b1.4 PHONE NUMBER: (Spq) --d'9 J MAILING ADDRESS: E • 6131 D -5P eA31,(e_ S1OO ACJ e_ Lot9 99 2 0(o (Street) (City/State) (Zp) _ MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = ..,.. , :.,_ i}vti:isl4iiiwGi::i-_:___..:.A._nv.._.:v..n....s_, vwi:iiivSx`.x:vwxi-:i'...::: :i'Oiii:i._.._\ x 25.00 = GAS WATER HEATER x 10.00 = GAS EQU M <1 ...�: � ...ddtdd0 GTIN �O�S=><>=�=>=<=<===><=`><�>`'>= x 12.00 - GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 GA IPING -EA:QUTI_ ::::_::>:::: _ BOILER/REFRIG 1-100M BTU 1177 ? 7- O 3?TV ` 3 . x12.00 - : ;��:n-_ v.4. n0.vw whv�i w:�Frn,G.w:.:e:_1:.v�vK,1wn" vnxv Ar.Qx1�'•n•�.hhfe me h:}r BOILER/REFRIG 501-1,000M BTU - x 25.00 r' �+n^"+^ ,�...�,�.�,�,n..w.,.n,�.:;nw<M:} :.s;::n,_n•:n•,n-n_.:-�:�{:�y-_ s•.c,o- n .. � -- BOILER/REFRIG+1,750M BTU . x 60.00 :_-: Mf? 'I�t t# "T , n"` x 12.00 _. EA :..f'�t1N. � ��QI�D::I.31�i t�l�]5:;::;>:_��` � _ - � --� � t HEAT PUMP&AIR CONDITIONER 3-15 TON` ---=-• x 20.00 HEAT PI 1M.p&AI.R CONDITIONER 1.5- ,TONS:._:=<_:;. .: <; x 2 - ac. a.:,..w..:,.:,.-..w..Caw..dos,•:n.......::n'..,•.,._w...s.'.,.a�::.•..:v.,�,..-n,� ..,, •:. __, a ... ,. .:. S.OV- �..-.- HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = y .w�:�:n..n.•.:...�...;x�;w,.,:.,::v..•.:-.:•_;;-:::. ::•;c:;:F+nc-•::;�.W..,+�oac;;.;o-:;;-; r,.>F:=.;.; .E.A'';1'L1MFP AI-[ C ONDTh t EI+50 TflNSN?'I x 60.00,_. VENTILATING FANS x 10.00 = p.....;•...n., ::,,N:n;,,:F:,F•.�k3_>sft;r:;>:;s,,�,:M:r >>: ,,..>,;,x.v,_z��.,..,_,,,,.::�x•::'Y ._ -___.. .. ;1rVAPORi.TlV'E O( OL-ERS x 10.00 = TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 ...:.......... CLOTHES DRYER x 10.00 = G x 10.00 = GAS LOG / x 10.00 = /0 o b MISCELLANEOUS(NOT.COVERED ELSEWHERE :`<: ; : x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GAS APPLIANCE>400 000 BTU :;;' .:::< x100.00= USED APPLIANCE<400,000 BTU x 50.00 = SUSD :.:... . , :::. :. ;;.:,:; .;.>;.;:_, >- »> �> > >�<�<<`< � =�><<>>�>< E, APPLIANCE>400,000 BTU __...... ...-: . x100.00= AIR HANDLER<10,000 CFM x 12.00 = HAND R x 15.00 = c� SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT / FEE DUE =3 10 SIGNATURE County Division of Buildings