APP-M-24-219407BUS. PHONE( 561 ) 383-3855
NOTE: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180-DAYS OR IF ACTIVITY LAPSES FOR 180
MUST BE ON THE JOB SITE FOR ALL INSPECTIONS. FINAL IW.CTION IS REQUIRED ON ALL PERMITS.
DAYS. PLANS
STATE OF FLORID
COUNTY OF PALM :EACH
The foreoing instrument was acknowledged be
this 7TH H day of JUNE - -•'
.. r.; physical presence or [] online notarization
•. y WALTERWEISS,JR
(Print
Signature of Notary P
REV 5/2023
personally Known XXX
Produced Identification
Type of Identification Produced
MY COMMISSION
EXPIRES 2.25-2027
blic - State of Flori a
#1114c NU?AB
MECHANICAL PERMIT APPLICATION
(HVAC, REFRIGERATION, HOODS, SUPPRESSION)
3LPS'C 4 mLS iqc4 8
PROPERTY CONTROL#: 12 - 43 - 46 - 16 - B6 ..000.. 0010
PLEASE PRINT: FILL IN COMPLETELY. INDICATE "N/A" WHERE APPLICABLE.
JOBSITE ADDRESS 51 N SWINTON AVE
PROPERTY OWNER NAME CITY OF DELRAY BEACH
HOME PHONE ( 561 ) 243-7339 CELL
PROPERTY OWNER ADDRESS 100 NW 1ST AVE, DELRAY BEACH, FL
MECHANICAL CONT'R (COMPANY) NAME A-EXCELLENT SERVICE, INC
MECHANICAL CONT'R (COMPANY) ADDRESS 9121 N MILITARY TRL, STE 103
CITY PALM BEACH GARDENS ST FL ZIP 33410
E-MAIL aexceIIentservaoI.com
FOR OFFICE USE ONLY:
CELL( )
FAX(
TYPE OF INSTALLATION - CHECK ALL THAT APPLY FOR THIS CONTRACTOR:
DESCRIPTION OF WORK: RESIDENTIAL NEW IS THIS AN EXACT CHANGE-OUT?
XX COMMERCIAL xx REPLACEMENT YES NO
El
Wet Chem: H2O:
Dry Chem: Clean Agent:
OR 64974 CACO24382
WORKERS COMP# EXEMPT (FID /FEIN) #
ADDITIO 'AL IESCRIPTI I
/14
SIG ATURE I F QUA FIER CONTR. REGISTRATION #
El
OR LIKE C/O OF (1) 5-TON SPLIT AC SYSTEM, NO ELECTRIC, NO DUCTING
HOODS - EXHAUST- BOOTH - BLOWER (2 SETS OF PLANS REQO)
Spray Booth:
Hoods:
SUPPRESSION SYSTEMS (3 SETS OF PLANS REQD)
PROJECT COST (LABOR AND MATERIAL):
$
REFRIGERATION
Equipment Type:
C.U. Model No.:
H.P. or BTU/HR:
E.V.A.P. Model #:
Effic'y Rating:
PROJECT COST (LABOR AND MATERIAL):
CITY OF OELRPY REP(H
100 NW 151 Avenue Delray Beach FL 33444
(561) 243-7200 Fax: (561) 243-7221
Website: www.delravbeachfl.qov
BLDG PERMIT i4:
MECH PERMIT #:
PERMIT FEE:
PLAN CHECK FEE:
MCR#:
APPROVALS:
MECH: DATE:
PLAN: DATE:
FIRE: DATE:
INDICATE IF
SMOKE TEST IS REQUIRED
HVAC: **ANYTHING OVER 5 TONS MAY REQUIRE FIRE DEPT. REVIEW/APPROVAL**
C/UMODELNO.&C/B SIZE RAI46OCC1NB KW 5 K
A.H.U. MODEL NO. & C/B SIZE RH21Z6021 STAN C/B SIZE 60/60
BTUH CAPACITY 57000 S.E.E.R RATING 15.00 PACKAGE UNIT: NA
DUCTWORK: (Y) NO (N)
TOTAL PROJECT COST (LABOR AND MATERIAL): $ 9984.00 Before Rebates