2003, 11-13 Permit App: BLD-03-03057 Furnace, Piping*lane
Valley
PROJECT � A
ADDRESS: J&% / 2t f /(- v?
l�aJit_
OWNER: or-SO-ti
MECHANICAL PERMIT APPLICATION
MAILING ADDRESS: p o . 50c 2- ^S- Coit.291 `�P/` �4 - ^cal
r , street c -(J 7
CONTRACTOR: ( (City/State) (zip)
'Cfr��..'i�r,,�.. pp LICENSE #:
MAILING ADDRESS..
PHONE #:
cyb co.? —yob
/L1 L ZE- SPoKaie' w4- /g216
(street)
PERMIT Gac L �
(fiJ
USE: N elf%) GaS [until -
PHONE (Daytime Contact): ) Cr -,5//
(city/state)
(zip)
BANS'.CARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORX
# OF uans
Y
COST
EQUALS
AMOUNT
1 FUEL BURNING APPLIANCE
= OR -100,000 (
X
$15
•
/S•
2 FUEL BURNING APPLIANCE
>100,000
X
$19
•
00
3 UNLISTED APPLIANCE (ADDITIONAL FEE)
=OR<403,000
X
$50
_
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
>400,000
X
$100
•
5
USED APPUANCE(VSEC 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 4
1001-1,750M BTU
X
557
=
11
BOILER/REFRIGERATION
+1750M BTU
X
595
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
- -
,
X
$10
=
13
RANGE
-
Xl
$10
•
14
DRYER
-
X
510
_
15
16
FUEL BURNING WATER HEATER
-
X
510
•
MISCELLANEOUS FUEL BURNING APPL
- -
X
$10
-
17
GAS PIPING (ea. Outlet)
-
,
X
$1
-
i
18
DUCT SYSTEMS
-
X
510
=
19
VENTILATING FANS
-
X
$10
•
20
AIR HANDLER (DOES NOT include ducting)
=OR<10,OOOCFM
X
512
=
21
AIR HANDLER (DOES NOT Include ducting)
>10,000CFM
X
$19
-
22
EVAPORATIVE COOLERS
-
X
$10
•
23
TYPE IHOOD
-
X
$50
•
24
TYPE II HOOD -
-
X
$10
=
25
HEAT PUMP/AIR CONDITIONER
04 TON
x
512
-
28
AIR CONDMONER
3-15 TON
X
520
•
27
AIR CONDITIONER
15-30 TON
X
525
28
AIR CONDITIONER
30-50 TON
X
535
=
29
AIR CONDITIONER
+50TON
X
$60
•
30
LPG STORAGE TANK
-
X
510
•
31
WOOD OR PELLET STOVE/INSERT
-
X
510
•
32
W000 STOVE - FREE STANDING
-
X
$25
=
0
DATE:
ac, -00
CASH IICHICK 0 '=:'..:� s:'•;. 0
PAX=PERAL7i WILL ONLY EE Ar_PTPD'MTH PAYI:ffY{
OP A MAJOR CRE NT CARO
- EXPIRES:.
PLUS PROCESSING
FEE
835.00
/
TOTAL PERMIT FEE I/
1
5_/-06 /-O6
BANS'.CARD NUMBER:
AUTHORIZED SIGNATURE: