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1993, 05-13 Permit App: 93003485 Furnace, Piping r-, , MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDR,E� S: / 4/ 23 ` 13,6e CITY/STATE/ZIP:_� % �� �-•'cam, PARCEL NUMBER: OWNER: Git-e'Z 1'�f ' PHONE NUMBER: ?A-6-,2`33 MAILING ADD ESS: 4-<2/1'), `e• cum e "011e Street) (City/State) T (Zip) CONTRACTOR: J-Atitid,rezzi- .41,--e. 3'� Je�'f L LICENSE NUMBER: •I- L a. 6 O 9' a 0` MAILING ADDRESS: <15 <15 G ,sild.76Z/z)Z., 't/ /00 t& (Street) ti (City/State) (7P) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = - - �!yv <;::};::<:;:,,:.<{Y':• :>}:{ {< rx: x 25.00 = •- :� ����������:iR�t42�a<L�,bX>r.i;.#.;.�;,;xz���.a22o:,�+:zYS::F.,/-:::;.`.-. GAS WATER HEATER x 10.00 = M ., g ": farn "' °" as ebe �.,.:,: ,:�. x12.00 = / G GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = ���•x .:1}jT�- ' < ,- , : '� <:'- : , cY<t: x 1.00 = / : '- `�•''�cJ..a�y ,,:F• g �``�� ho��>}iS:.v}}.a.vsS t:+�ai?>'.\' ;:;;,}`7:yy'r BOILER/REFRIG 1-100M BTU x 12.0b = ` f3 e WK ;, ' .:., ', , f'' x t. ; x 20.00 = • BOILER/REFRIG 501-1,000M BTU x 25.00 = � „ r „ <,: w .>{y,. ` x 35.00 ��I+ 'v�,Fit $.':,..RYa:.��<;:� ��.B�{ �r SS:.�:.,sic{x%iiki:c :;{:.k{.�''3? i.• BOILER/REFRIG+1,750M BTU x 60.00 = /},p�/`} y} p �+{/J:,Y�..�./�' }y �:•. ;. x 12.00 W..}\MMMk.M. ..ir.•.Y-•�,!..�7v ?•.�^! ?"�:3�lGf�,1�'hw's':'+,,'<''s:::„ '' :'{,\'••': HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 = b',7 ky�� ;:s , } x 25.00 HEAT PUMP&AIR CONDITIONER 30-50 TONS • x 35.00 = " gg r>lg 4 5 x 60.00 = VENTILATING FANS x 10.00 = $ $�Ly <;,,, ' ,,', '; ::>>~}<.;i{:,;',A,, (, x 10.00 = �..HLn/P�$�.��� •^v!S��Sn>Na��}.�:� k ." }\3iK1�S { - TYPE I HOOD (PER 12' OR 12' PTN.OF HOOD) x 50.00 = :++��a 6 ori pc':4i:'":I, "(,-,'. F-' ,'",'.: 5:;'',,:r<'{:#:C;c;,', ',``, ''',:v7- x 10.00 = V/•tJ �7 :.{.v.t...'r•:`f'Y !%.�s} �•/CJ.,�.9.ftiµi.Y2:: %rSX{ Y :. �> `<� r,�.•. :. .. ?r �::>� .«;. ���{�:�{»,;�;az>..<s:yfz};z�3',;..: � s;>,z�,�.r,.��� ; CLOTHES DRYER x 10.00 = or>r. may., <v.. {.,•. ": %{+r,,.• v. ' a':',u ,,: ',,-, .,a ,,,',.?`':x: ", '; 1':,-: 3 :<r.6.', x 10.00 = � '�c�s,,.# k't'i4�.�,'`{�}Y � .:.. •s%X:};Sv�i�a:'i�a'.".'}'a .;�.c,1:1:'.. `S'. 't.gy,<:s'.,,,. GAS LOG _ x 10.00 = B) °: :' gig . . . . ` :. " .. ., x 10.00 = UNLISTED GAS APPUANCE<400,000 BTU x 50.00 = f .?':. T ':;', . sof x100.00= "� USED APPLIANCE<400,000 BTU x 50.00 = Ia S is ::CC `.,6 Cal/6): t { '.{' x100.00= AIR HANDLER<10,000 CFM x 12.00 = ErERAMEIf {i1i, ' }Y x 15.00 = SUBTOTAL $ ) PLUS: PROCESSING FEE +$ 25.00 NOTE:. MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT FEE DUE _$ a,t. di a SIGNATURE /4;`"r/ "c