2003, 11-24 Permit App: BLD-03-03144 Insert, PipingSame
4.00 Valley
PROJECT
Z2 U, 0
ADDRESS:
OWNER:
MECHANICAL PERMIT APPLICATION
/�,i �n (� PERMIT �7
��t1 D V UI I l R VA/1 (-`n Cr- USE: l CeF�C'tt 2_ ryraft -1 reS r`l/(IMQCF 3-
�(!r_ _ , S Ot (_ r S4 �i/I"carA y PHONE (Ddytime Contact): 9' 7 / _ 3"'! l� O
'--7� j -F 7/+
00 N. tln�hr,, t'�"� 2P07(„�-.Q C %%�. 9!"ZOC�
(street) 't J (city/state) • (zip)
LICENSE #; - -
MAILING ADDRESS'Z
CONTRACTOR:
G
C:y\ (X
c
fact#EPri} mm3. — r_CHF1919-44
PHONE #:
sl) C 7 2-7 rib
H 4OE . CCAttldt, SK'u) ,Q21
(street)
(city/state)
zi
BANRCARD NUMBER:
ATJTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# op mu
X
COST
EQUALS
AMOUNT
1 FUEL BURNING APPLIANCE
a OR<100,000 /
X
$15
2 FUEL BURNING APPLIANCE
>100,000 (
X
319
a.
3 UNLISTED APPLIANCE (ADDITIONAL FEE)
=OR<400,000
X
350
a
.4
UNLISTED APPUANCE (ADDITIONAL FEE)
>400,000
X
5100
a
5
USED APPLIANCE(WSEC min. AFUE rating)
a0R<400,000
X
150
a
6
USED APPLIANCE(WSEC min. AFUE rating)
>400,000
X
$100
7
BOILERREFRIGERATION
1-100M BTU
X
315
a
8
BOILER/REFRIGERATION
101-500M BTU
X
$28
9
BOILER/REFRIGERATION
501-1,000M BTU
X
539
a
10
BOILER/REFRIGERATION ,
1001-1,750M BTU-
X
357
a
11
BOILER/REFRIGERATION •
+1750M BTU
X
395
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
- .,
X
310
a
13
RANGE
-
X
- $10
=
14
DRYER
-
X
$10
15
FUEL BURNING WATER HEATER-
X
310
16
MISCELLANEOUS FUEL BURNING APPL
-
X
310
=
17
GAS PIPING (ea. Outlet)
-
X
31
=
18
DUCT SYSTEMS
-
X
510
=
19
VENTILATING FANS
-
X
$10
=
20
AIR HANDLER (DOES NOT Include ducting)
aOR<10,000CFM
X
$12
=
21
AIR HANDLER (DOES NOT Include ducting)
> 10,000CFM
319
a
22
23
EVAPORATIVE COOLERS-
$10
TYPE I HOOD
-
X
$50
24
TYPE Il HOOD-
X
310
a
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
S12
28
AIR CONDITIONER
3-15 TON
X
S20
a
27
AIR CONDITIONER
15-30 TON
X
325
a
28
AER CONDITIONER
30-50 TON
X
$35
=
29
AIR CONDMONER
.+50TON
X
$60
a
30
LPG STORAGE TANK-
X
$10
-
31
WOOD OR PELLET STOVE/INSERT-
X
510
=
32
WOOD STOVE - FREE STANDING-
X
E25
.1
.'
..u-_.•,::: "_:
VITT(
CARD
.
SUBTOTAL
•
CASH • CHECK ■ ;;:r,,.. n.. 0
FAXED PERJ TS IV=ONLYDE ACCEPTED
OP A MAJOR CREDIT
- EXPIRES:
DAT&:
PLUS PROCESSING
FEE .
$35.00
TOTAL PERMIT FEE44
DUE
�1,t
e (- UQ
BANRCARD NUMBER:
ATJTHORIZED SIGNATURE: