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1992, 08-12 Permit App: 92006361 Wood Stove Sv MECHANICAL PERM APPLICATION FORM Information Worksheet l� /,--,5L-t- 7 fI JOB STREET ADDRESS: 1 PE 75a CITY/STATE�IP: �QI� C(c l/Ucy 't 905 7 PARCEL NUMBER: OWNER: rTh)0hn LV r PHONE NUMBER: ' •337 MAILING ADDRESS: c 4' c! (Street) (City/State) (Zip) CONTRACTOR: rq C c C le_b .iki CF/J.Fs2 LICENSE NUMBER: r4 CO r-/C.,1-7-3 b1.4 PHONE NUMBER: (SO 61) clj --S79/ MAILING ADDRESS: L • 013, p :54D P- 1:S riniE'r 1.<) 992cc (Street) (City/State) (Zip) ._ MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = WOC bSTOVEIINSER >:::::::ag...:::.;:::::::::: - I x 25.00 = as- - GAS WATER HEATER x 10.x::0 = GAS EQUIPMENT<100t00O_3TU(INCL 3DES;<-_,_=>:;; x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = 1 = GASPIPING I`A Q13TL x .00 ....::::..:.>:::. . ... . . BOILER/REFRIG 1-100M BTU - - x 12.00 = - OLS - x = 1 - 20.00 1 1=II=1=1� .��3 .-StSt�MMf S _. BOILER/REFRIG 501-1,000M BTU --- x 25.00 = • BOILERIAEFRIG 1 000150, M BTt3> ' = x 35.00 = ............. ... BOILER/REFRIG+1.750M BTU ___ - y x 60.00 = EAT P 1MP;tAIR CtONDII 13NER U-3 TONS :>;: =, x 12.00 = HEAT PUMP &AIR CONDITIONER 3-15 TONS - x 20.00 = HEAT PUMP&AIR CONDITIONER 15:30 IONS = x 25.00 = HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 = HEAT PUMP.&AIR CONI ITIONEP+ 0-TONS:.. >:>:`:::>; x 60.00 = VENTILATING FANS_._.:::'. ::..: :.:..::..:..... ..... _ x 10.00 = x10 00 = O COO S. . ....... ... .. TYPE I HOOD (PER 12' OR 12' PTN.OF HOOD) • x 50.00 = x 10.00 = DRYER HES CLOTER-...::.::... x 10.00 = • CLOTHES .............._ RNGt x 10.00 = GAS LOG x 10.00 - 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 = USED APPLIANCE>400 000 BtU... ...: . x100.00= AIR HANDLER<10,000 CFM x 12.00 = AIR HANDLER>10,030'CFM-.. x 15.00 = "I SUBTOTAL $ uy PLUS: PROCESSING FEE + $ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE = $ j ^ . .TUBE