APP-MDAYS. PLANS
CITY PALM BEACH GARDENS ST FL ZIP 33410
BUS. PHONE( 561 ) 383-3855 CELL
E-MAIL aexceIIentservaoI.com FAX (
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 II'1ECTION IS REQUIRED ON ALL PERMITS.
ADDITIO AL DESCRIPTION OR LIKE C/O OF (2) 20-TON SPLIT AC SYSTEM, NO ELECTRIC, NO DUCTING
64974 OR CACO24382
WORKERS COMP# EXEMPT (FID /FEIN) # SIGNATURE OF QUAL
STATE OF FLORID
IER CONTR. REGISTRATION #
CITY OF ORRY BENCH
100 NW 1 31 Avenue Delray Beach FL 33444
(561) 243-7200 Fax: (561) 243-7221
Webs ite: www.deIravbeachfLvov
MECHANICAL PERMIT APPLICATION
(HVAC, REFRIGERATION, HOODS, SUPPRESSION)
FOR OFFICE USE ONLY:
PROPERTY CONTROL #: 12 -43 - 46 - 20 - 50 - 002 - 0000
PLEASE PRINT: FILL IN COMPLETELY. INDICATE "N/A" WHERE APPLICABLE.
JOBSITE ADDRESS 510 SW 8TH AVE
PROPERTY OWNER NAME BARBARITO GERALD M DD JCL BISHOP OF
DIOCESE OF PALM BEAC
HOME PHONE ( 561 ) 276-4880 CELL ( )
PROPERTY OWNER ADDRESSPO BOX 109650, PALM BEACH GARDENS, FL 33410
MECHANICAL CONT'R (COMPANY) NAME A-EXCELLENT SERVICE, INC
MECHANICAL CONT'R (COMPANY) ADDRESS 9121 N MILITARY TRL, STE 103
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
NO
C/U MODEL NO. & C/B SIZE RACL224OC 100 AMP
A.H.U. MODEL NO. & C/B SIZE RHCLA2240C C/B SIZE 60
BTUH CAPACITY 240000 S.E.E.R RATING EER1 0.0 PACKAGE UNIT:
Before Rebates TOTAL PROJECT COST (LABOR AND MATERIAL): $ $173,770.00
Wet Chem: H2O:
Dry Chem: Clean Agent:
HVAC: **ANYTHING OVER 5 TONS MAY REQUIRE FIRE DEPT. REVIEW/APPROVAL**
DUCT WORK: (Y) NO (N)
X 2 KW 15 KW
HOODS - EXHAUST- BOOTH - BLOWER (2 SETS OF PLANS REQD)
Spray Booth:
Hoods:
SUPPRESSION SYSTEMS (3 SETS OF PLANS REQU)
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):
$
APPROVALS:
MECH: DATE:
PLAN: DATE:
FIRE: DATE:
INDICATE IF
SMOKE TEST IS REQUIRED
BLDG PERMIT #:
MECH PERMIT #:
PERMIT FEE:
PLAN CHECK FEE:
MCR#:
COUNTY OF PAL BEACH
foregoing instrument was acknowledged The fore e, means of [] physical presence or {] online notarization
this 1 T day of AUG US/,. oTM by WALTER WEISS, JR
(Printed Name of Above Signatory)
f
REV 5/2023
00~"/q ~7-
Signat e of Notary Public - State o
Personally Known XXX
OR
Produced Identification
Type of Identification Produced