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1992, 04-22 Permit App: 92002776 Wood Stove n �'` 7sk-t 3- 55-0,-k - CHANIC'�AL b PERMIT APPLICATION FORM Information Worksheet G2o Fj 3 JOB STREET ADDRESS: E . . 13 702 3 G' CITY/STATE/ZIP: U O. 1.ca jQ , (,_.,t4 6-°iO 3-7 PARCEL NUMBER: OWNER: 'Irl A n Q wr e.,n shAw PHONE NUMBER: qc2.,:Z MAILING ADDRESS: r (Street) (CEry )/State - (Zip) CONTRACTOR: r P' kr' CI4(ZDriJ CE,JfFyZ LICENSE NUMBER: F4JC-0CSC1-73Dt�( PHONE NUMBER: (SOq) q)(,-g91 / MAILING ADDRESS: E • 6131 D Sp2A91,(e, � A,,j� L>A 992 Deo (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = . O ST El#.S E3rai:=;:::.-::r: > .... . ...: . . aP _ x 25.00 - r. . �<.,.........a•«..w.....m.w..:,..www...w.......t,..,..;..sxa.•.xra:-s-....aw..•,or:<vu;ireuara.a....�:.<:-:s:J:x::wxzetl.:w>•:. GAS WATER HEATER x 10.00 :SAS EQt1.1PM 'C100,00< Tl NFS -. H j x 1208 GAS EQUIPMENT+100,000 BTU DUCTWORK) - • - x 15.00 `` :GAS' PIPING' gA:OUTL_: .. «,t->;:>•.::.: ..>.. :::::;:<- X1.00 a;:� {�� Ts .,.�-_:. BOILER/REFRIG-100M BTU - . __ x 12.00 Y ..r -'3 <.�,JS. .E-� .10 : ^M1 . Ja.c.caG sc.'hv......,s✓a`_< '+ � .Lv.... J.. •x 20 00} � - �.„ .. 7F~ ...w. �_.�� .l�•+.._ - - � ,; � ''rc P....;=`•.*r � \� BOILER/REFRIG 501-1,000M BTU. _ y - ...-a :-.�9 sw. ....�� � ,� . 4 _.,K yn'y,.... rr i `rY`i 1r• i Ti �-i _�. x25.00 x� , -;:�7;:: r• ..G:<-k.. <:::x r:.co:�.::...:a- •r. �a - ..�.. y'brP. r'..._��.Y.h•.'-�a3: :.a. .1 r�Sv t BQ x35.00 BOILER/REFRIG+1,750M BTU x 60.00: Y„•ry` �`."` k _ j /SND ON Pi o .t ` :_, #-�3"7flNS ,�..4 J `� K :.._.. X12OO...,i • . 13"�-y}�.~aYh�I'+ 1117.7.,SK'W HEAT PUMP&AIR CONDITIONER 3-15TONS x 20.00 , F-A PUM, AtR CC nlb.;T)NEI iTaTi )SIS-.",, �;. �. t_.. .x25.00 fP>' y O.IODA:.r ... .. v SCfw- � . � �.s.Y`.•.+V .... HEAT PUMP&AIR CONDITIONER 30-50 TONS'-*.'"-: t x 35;00:5=7.7: :: , ->:MpZq<tR CONK SON ,+�0 TUt�IS�..,. l x 60.00 �~ ?, .r�.•�f �• VENTILATING FANS Y�- 4s - '"' `� `- _ ^" X 10.00::=7.- t 0.00 _ _ ...r.rwf r`J }�• i� -,�.. t�•yr <�e••.�•.�u��>;na �•�«+r•�xec:'. _ - - �EVAP 3.RATIVE COO.L1=R5. .:..:<:.»: ;.;:::,.<:;�:<;:;.f :::>: x 10.00 � ' .......w.......waod6coww,�;..�::a ,...w•:.-: ..w.:..S.v-o:� TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD),'.=...--- • x 50.00 - -- " is - _, . • - _ :ww..va.�Y+-?:^'. - i...T}.a.+.-?:!-;i:<•ii:4>t}:n:.Y.}i_?>i>'>Yx}Y.:.:{?:i:. w+w r/w -.t:•.tn:..w.wl..v.:+vmvrr:v.a•::.-::::. x 10.00 = CLOTHES DRYER -' x 10.00 = - x 10.00 GAS LOG - x 10.00 = x 10.00 = MISCELLANEOUS OT COVERED ELSEWHERE UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GASAPPUANCE>400000 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 iANDLER>10,000.:CFM;:' x 15.00 = SUBTOTAL $ 0154)2 PLUS: PROCESSING FEE + $ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT pp FEE DUE = S SIGNATURE a ^,tVrJfV:S, . :._ -7777 C1� - `li `