1989, 10-04 Permit App 89003797 Pellet InsertPARCEL N(IMBER:
INFORMATION WORFSHEET
STREET ADDRESS: 7 /- Ja,� 1,6--te?--1
CITY/STATE/ZIP: Y�/r % /29D.,F7
SUBDIVISION:
BLOCK: LOT: ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
OF BUILDINGS:
f OF DWELLINGS: WATER DISTRICT:.
,1-z) v1,4h/,),/
lety
BAILING ADDRESS:
CITY/STATE/ZIP:
CONTACT:
0/1
SETBACKS: - FRONT:
r:i:1;1 T USE:
LEFT:
BONE:
PHONE:
RIGHT:
REAR:
f 7 T i...... X:* s s s, ,,s 2 X X X Y X X X X X* X 2% 2 2 X X 2 X X X 2 S X* X X M 7 X X X X X* 2 S f. X R*.** X X X X* X X 2*! X R
BUILDING INFORMATION
"):+.:U,CTOR I.TCi-ZSE NUN,I3ER:
C •uNTRAC: l OR : PHONE:
r,AI I.I t:G AI)I)i:Ei;S:
:.'.Cii1 TECT/ENGINEER:
I Al I.I NG ADDRESS :
NEW: ,„1<F_►rDE : ADDITION: CHAN OF USE:
PHONE:
I`•ri::LL
OCCUPANT IOAD:
UII.Dit:G DIMENSIONS:
i? :Q'JI I?ED i'ARKI2IG:
x
BUILDING HGT: STORIES:.
1 HANDICAP:
(wlix u X DEPTH ) SQ.
SEnE.R (Y/N) :
HYDRANT:
CONTRACTOR:
'-?LING ADDRESS:
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MECHANICAL INFORMATION
CONTRACTOR LICI : M. Ld od & /`73n. )
CONTRACTOR: Mice) O g4fp4 . deivrficae, cam" -� - �/�•p �� j
! -.I LING ADDRESS: L..E .93%O SM�4 &?5::' �7�0/l NE GCI�_ IR:e ict,
f J l
ELECTRIC: GAS: OIL: CCAL: WOOD: / SOLAR: HEAT PUMP
ENERGY CODE: WSEC: NWEC: UTILITY: SGC:
APPROACH: PRESCRIPTIVE: POINT:
n o:zxrrrrrzrrrrr:rrrrrr::zzrz:s it%t::rrazssrrrzzz:::::srrrzr:rs:::zz:zr
COMPONENT: SYSTEMS:
MECiHANICAL FEES
M DESCRIPTION
C:`ESSI NG FEE
cre:c.)R1-1 SYSi•t-ms.
WATER HEATER
R
IiTG E2UIPc20G,O:i0)1, 0
S ii1G EQUIP -100,000
NUMBER OF
S PIPING - t OF U!:7TS
:.TPUMP 1-10G BTU
..TI>UMP 101-500 BTU
.,.'PUMP 501-1000 Ball
ATPUMP 1 001-1750 BTU
A?PtU P +1751 BTU
Pi-3G 1-100 BTU
' RIG 101-500 13T1J
iIIG 501-100 BTU
Pi.IG 101-1750 BTU
PRIG -11750 HTJ
CO.NDI T1 ONER 0-3 HP
• OONDITIO':ER 3-15 HP
R CONDITIONER 15-30 HP
▪ CONDITIONER 30-50 HP
• Cli NDIT'IONER i 50 HP
TIIJ,T'ING FANS
..I:ATI VE COOLERS
: 'S I,i:�r:R
YES OR NO
PLUMING FEES
ITEM DESCRIPTION
PROCESSING FEE
TOILETS
SI NKS
SHOWERS
B= TUBS
KITCHEN SINKS
DISHWASHERS
GARBAGE DISPOSAL
OSAL
CLOTHES WASHER
UTILITY SINKS
ELECTRIC WATER HEATERS
FLOOR DRAINS
FLOOR SINES
!3?.I: SINKS
ROOF DRAINS
IJ.WN SPRINKLER
SEWAGE EJECTOR
WATER SOFTENER
URINAL
DRINKING FOUNTAIN
NUMBER OF
YES OR NO
::D CAS APPLIANCE
:>I.i:iR 1-1 GMiG0 c'iY