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1994, 03-09 Permit App: 94001841 Mechanical Fixtures _ ,.. , * • .^. 64F ( tg qi / MECHANICAL PERMIT APPLICATION FORM • Information Worksheet /0 z-- L-- / JOB STREET ADDRESS: _7_ k.p r) 7 J-, / 3 .---14--L-' _____„ , . CITY/STATE/ZIP 51.,-)../,./. PARCEL NUMBER: PHONE NUMBER: 6s4z: MAILING ADDRESS: 77,___ : - (Street) I/ CIty/State) (Zip) CONTRACTOR: /12 _ XL-0 :L___,IL. ________LICENSE NUMBER: A I A.' • ii/ PHONE NUMBER. .--- , - A MAILING ADDRESS:_k __.5- /0 .? I ..-rt.--y, ' Cz...4;..... -2-44- 79-°/cA (Street) / (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT .AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 kg WOOPS0001111011. . x 25.00 22 GAS WATER HEATER / x10.00 a GASI:EQt0M:011700*CATVONOLODES.igg,'A ( x 12.00 GAS EQUIPMENT +100,000 BTU DUCTWORK)0 x 15.00 = , GAS PIPI14(M..0010)1011ktiii!!5P.ji::: kn:011iiii:,:: / x 1.00 In /• 0 0 BOILER/REFRIG 1-100M BTU x 12.00 = 6OLF.*R.gMt..G,O1 WMK:arr:::::11::iaggtaild:6:' x 20.00 I= BOILER/REFRIG 501-1,000M BTU x 25.00 es BOILER/ROV01.000.141;5010TV:MMil7iin:Ms5p x 36.00 nu BOILER/REFRIG +1,750M BTU x 60.00 =, HEAT,PVMPOIR.:.CONPIPPISMR:04.1,00$; ',;ii:;;;.:44,a x 12.00 In HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 .2 .. .. .HEAT PUMP&'AIRCONPITIPRORit$440•Toosimiirl:: :.• x 25.00 In , HEAT PUMP & AIR CONDITIONER 30-50 TONS x 35.00 20 HEAT PUMP.:.&:AIP CONDITIONER +50 TONS x 60.00 VENTILATING FANS x 10.00 = EVAPORATIVE COOLERS.:.::: ;:.:-i.. .0,,' .:',1:.,... : •. ....0.,:0..::..T1': :: x 10.00 n= TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = .._.... ...._. TYPE II HOOD ' • ' . :i:• :', 0 H..:0.. 1•':•:: . .:•,°'''':'!: ::: x 10.00 CLOTHES DRYER x 10.00 RANGE ..0 • . . :. , .: '. : • ' '''''•.'..:. ,-. x 10.00 GAS LOG I x 10.00 = .„ :::....:.: ----------I -----, kli$QE.V4NEQUSINO'r COVERED I.E:LSEWHERE:.:::,„ :0, 1 x 1,0.00 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 = ------- ._ USED APPLiANGE>40,000•Vil :::•::. .•...-••• ., H•,:., •••.:. ::•..:',• :;:],iiH , --- xi oo.00 = AIR HANDLER <10,000 CFM x 12.00 = MR HANDLER >10,004 CFM' ' • :. .0 , 0 .0!°.:„:1 x 15.00 n•-• SUBTOTAL $ Z3.00 PLUS: PROCESSING FEE + $ 25.00 NOTE: MINIMUM PERMIT FEE iS$35.00 EQUALS: TOTAL PERMIT FEE DUE = $ SIGNATURE