2003, BD03-136 InsertValley
MECHANICAL PERMIT APPLICATION
PROJECT
ADDRESS: ` f 1 I
PERMIT
USE:
# OF UNITS
OWNER:
r
r ',77-e..._
PHONE (Daytime Contact):
AMOUNT
1
MAILING ADDRESS:
-/
X
(street) (city/state)
=
(zip) 990 . 3
CONTRACTOR: z
Ar.05 C air ez-id
LICENSE #:
5c.A'
9
&1-1
MAILING ADDRESS:
4, 770
A3 (vizi eoe- N
PHONE #:
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
C:13
_4z-72 ,533'/ y
$50
(street) (city/state)
(zip)
•
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
= OR<100,000
X
$15
=
2
FUEL BURNING APPLIANCE
>100,000
X
$19
=
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
=OR<400,000
X
$50
=
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
>400,000
X
$100
=
5
USED APPLIANCE(WSEC min. AFUE rating)
=OR<400,000
X
$50
=
6
USED APPLIANCE(WSEC min. AFUE rating)
>400,000
X
$100
=
7
BOILER/REFRIGERATION
1-100M BTU
X
$15
=
8
BOILER/REFRIGERATION
101-500M BTU
X
$28
=
9
BOILER/REFRIGERATION
501-1,000M BTU
X
$39
=
10
BOILER/REFRIGERATION
1001-1,750M BTU
X
$57
=
11
BOILER/REFRIGERATION
+1750M BTU
X
$95
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
X
$10
=
13
RANGE
-
X
$10
=
i`Q
14
DRYER
-
X
$10
=
15
FUEL BURNING WATER HEATER
-
X
$10
=
16
MISCELLANEOUS FUEL BURNING APPL
-
X
$10
=
17
GAS PIPING (ea. Outlet)
-
X
$1
=
18
DUCT SYSTEMS
-
X
$10
=
19
VENTILATING FANS
-
X
$10
=
20
AIR HANDLER (DOES NOT include ducting)
=OR<10,000CFM
X
$12
=
21
AIR HANDLER (DOES NOT include ducting)
>10,000CFM
X
$19
=
22
EVAPORATIVE COOLERS
-
X
$10
=
23
TYPE I HOOD
-
X
$50
=
24
TYPE II HOOD
-
X
$10
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$12
=
26
AIR CONDITIONER
3-15 TON
X
$20
=
27
AIR CONDITIONER
15-30 TON
X
$25
=
28
AIR CONDITIONER
30-50 TON
X
$35
=
29
AIR CONDITIONER
+50TON
X
$60
=
30
LPG STORAGE TANK
-
X
$10
=
31
W000 OR PELLET STOVE/INSERT
-
X
$10
=
32
WOOD STOVE - FREE STANDING
-
X
$25
=
i
.___ _..__ _q
WITH PAYMENT
CARD
SUBTOTAL
■ CASH • CHECK • .NMI. ■
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS WILL ONLY BE ACCEPTED
OF A MAJOR CREDIT
nATV. VirnmVC.
TOTAL PERMIT FEE
DUE
r,
/ S UG
•
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: