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1992, 03-24 Permit App 92001815 Gas Log1`3554. °7 ` ;WECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: . ( g2�,,}---- CITY/STATE/ZIP: (�f �� � ,iA1'11 ? 1 I D) ((IPAf CEL NUMBER: - OWNER: 5 Y PHONE NUMBER: 1'0-) -50 )p r MAILING ADDRESS: CONTRACTOR: (Street) (City/State). - (Zip) C 4??c E,J C;✓/.11-Fti2 LICENSE NUMBER: F-4ICo &C I -73 DLL( PHONE NUMBER: (5Qq) c3'.2(.0-g911 MAILING ADDRESS: 6 _ q31 D S.0eA3L4e. LJA 992Deo (Street) ' (City/State) (Zp) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOOCSTOVEMSEIr<::}r{:v'«»>:>A<> >m:»;;>:>>:{; GAS WATER HEATER - _ ASi<£Qtf l?MENV IDOT 00 3T INC OD S rµ GAS EQUIPMENT+100,000 BTU DUCTWORK) <' z- _ '....,+.r .....ww.�"«.w..., .,o. -"..,,..."'^"` -....2u.:{.. •....nix^...-<.v4, :`.+r;x[^vte!u<...,M.'4> G. .:�i�iN�<�r..�1<ffl:tiTf� �.�M '-.,:�YAv+rw ,': �.':,...•.m;}k;v.<.«j, BOILER/REFRIG.1-100M •> 0'l'i'¢..4:. nMV...\i }r.}vy i•'�%i_'_<. BOIi_.ERIREFRIG 501-1.000M BTU; = BOILER/REFRIG+1,750M BTU_'' } i ; ;:i?I-:t 4tp....;9<AIIIICOND 019E1107,370NS>«: �.'17 HEAT PUMP 8: AIR CONDITIONER 3=15 TONS == =? E.:.. HEAT �aPUMP &AIR CONDITIONER 30-50 TONS`--=' i' VENTILATING FANS :`-=s..:� .'r"""-'� -•;.-:•= + t TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) ` CLOTHES DRYER - GAS LOG _ .!SCELLANEOiTS NOTC.OVERED E1S'EWH RE UNLISTED GAS APPLIANCE <400,000 BTU UL!NSTED GAS APPLJANCE>400,000 BTU USED APPLIANCE <400,000 BTU 'USED APPLIANCE>400. I00:BTU AIR HANDLER <10,000 CFM AI IANDLER:>10,000 Cr NOTE MINIMUM PERMIT FEE IS S35.00 SIGNATURE tia NUMBER OF UNITS ^"•��^ X EACH UNIT = AMOUNT x 10.00 = - .. - - x 25.00 _• _ •-- - . - _ _ x 10.00 =' x 12.00 - - _ _ ; - - x15.00 _ - - _.; -.. , _ x _00 -� r-: t�; .��'- - ,,,..,gin-... =:4%..:i .�L.. "...C: ' x 20.00 . _ :.2 ..cL2,Yt?t.:!�:-,T/r.,c.". .:, �--:, :. - - x 60.00 ;= ,:1-r:'- t: r- >rxct:. . =i'. :ycc'-,'-' :•*l-`.-.i:r., x 20.00 .. -:-:::,-- F...:T.. --• . -- , . x 35.00-7;7 t ;: .:.: "t....-: :e• ::.. _'1 -. _ x 60.00 = -' .- ,-:-.... '='. " �.� x 10.00 - .::= x 10.0V - - x 50.00 = _.. _ - __ -_ x 10.00 = - x 10.00 = x 10.00 = x 10.00 = % D �e x 10.00 = x 50.00 = . x100.00 = x50.00 = _ x100.00 = x12.00 = x 15.00 = SUBTOTAL S 7, -49 PLUS: PROCESSING FEE I + $ 25.00 EQUALS: TOTAL PERMIT / no FEE O U E = S -`' rtvDvis._.