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1991, 12-05 Permit App 91008403 Gas Log
�c) 8 CHANICAL P 13M1 i APP� C ��,� 1 � 5 e _ �'`AT10N FORM q \ - `�`403 5. of P co information Worksheet 53 JOB STREET ADDRESS: E• 1 Nob 3 ()A I 12 i,,: ,4 Li CITY/STATE/ZIP: Sri) IC. c.A.44 Q Q p(o PARCEL NUMBER: OWNER: S 1 I u A rl L. I () PHONE NUMBER: la I. - 3 7 7 3 MAILING ADDRESS: r (Street) (City/State) - (Zip) CONTRACTOR: r f- } C� CY 4 cp iJ CEti11-F►2 LICENSE NUMBER: i� ► - ICO &C, I -73 t to PHONE NUMBER: (5060 g.?(o-89 / / MAILING ADDRESS: E • (131 c .5peA914e, S pc')64/Lie- I,4..)A 992Deo (Street) (City; State) PP) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) W703S OINS:ffgrwnaWTn ? Y GAS WATER HEATER GAS EQUIPMENT+100,000 BTU DUCTWORK) I...w.w..:..ac:•..:.•S''?,^e;`:iS.Z>} r• Siydia,�r,.�wx.�s.ti•.ti BOILER/REFRIG.1-100M BTU sr.. - .. _ .. xd.c$:.vCG5o1¢�...,_,cn.. ex�;X:yJF•::u1 BOILER/REFRIG 501-1,000M ..� _ _ wr—•:max � •<«''-x� BOILER/REFRIG +1,750M BTU=`--.`w2~:'-'-t:r filt-)TWATrairkIF CONDR O'hEf 141.'i'ONS ' r 7F. HEAT PUMP & AIR CONDITIONER 3-15 TONS EAT.POMP A;R CONIC 2if7a-30 TtirtS _ HEAT PUMP 4& A1R CONDITIONER 30-50 TONS" = a FIE "VPUtuI.P is Co iyto El i-ToNtS�°°° , VENTILATING > i �• ,_.: �-.�; xM ., .W , �, .._,wywo.r � �w...:,wa:,.r�w:xx. �' �`�•'`w,.., 2Ciea�a.cw<;';::a' 'L..w�uaimi TYPE! HOOD (PER 12' OR 12' PTN. OF HOOD)' CLOTHES DRYER GAS LOG ;..!SC....:LA.. E :U...:.(N `:T....:...:V.....:.......:. ELSE:::......... v .. MfSC.ELCAN�O!✓S` "UTCOVE.RcLSEWrEf,?E�< UNLISTED GAS APPLIANCE <400,000 BTU UNNSTED GASAPPUANCE 4007040 BTU ':'Y ':. `: USED APPLIANCE <400,000 BTU USED APPLIANCE a400:L�00 BT{ix y' '>; AIR HANDLER <10,000 CFM 'AIR:;HANOLER10,00Q NOTE MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x 25.00 =- x10.00= x 12.00 x 15.00 _ x 12.00 - - - _ ... . .. -• - . , ' • - -. - . . __ a:-.;-.... x 20A0 z-,. . - , ; �r . ;�:.. - x 60.00 X - -- :.�Z�S f-,.,•'-- f1 .•. 1.r""-..---+ - -x 19,.00 x20.00 =: x25.00;:;, .: 3•u.:.jts•; ry .�.+:..' - . '=' r' _ _ . -' .e..:- .A.;'', 4 x35:00 �3 ':• -5;:-. K ..._ x60.00.._ w}...._,,-t - x 10.00 - _ ' :;': x10.00 •- . _.. _........-_ x50.00`_... ... _.. .. - -- x 10.00 = x 10.00 = x 10.00 = 1 x 10.00 = rr =— x10.00 = x50.00 = x100.00 = x5J'0.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ / / IPLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE pcy = S ,36 `— • .