Permit: BD03-021 Water Heaternxcor �0...
Sv11cy
MECHANICAL PER
O 9 -'o
80 03- ca l
PROJECT 42/�
ADDRESS:
` ( �,(,�
PERMIT
�
USE: M°" R.
OWNER: d, ,fin/
/ [Xit�A
!//;;rQ
✓✓
PHONE (Daytime Contact):
MAILING ADDRESS:
1
92 ll 2 e 2-8 8
= OR<100,000
(street) (city/state) • (zip)
CONT CTOR:
('�
v
n
t �h�p_
LICENSE #:
S2Cg 9' 5V/
AIL G ADDRESSci :
$ 270
FUEL BURNING APPLIANCE
..7/-
PHONE#:
I
`�^2rR) Zai OG W
GD/9- . .0 838) V
$19
=
(street) (city/state) (zip)
BANRCARD 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)
=0R<400,000
X
$50
=
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
>400,000
X
$100
=
5
USED APPLIANCE(WSEC min. AFUE rating)
=0R<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
557
=
11
BOILER/REFRIGERATION
+1750M BTU
X
$95
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
X
$10
=
13
RANGE-
X
$10
=
14
DRYER
-
X
$10
=
15
FUEL BURNING WATER HEATER
-
X
$10
=
,a, vV
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)
=0R<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
WOOD OR PELLET STOVE/INSERT
-
X
$10
=
32
WOOD STOVE - FREE STANDING-
X
$25
=
VISA' .)
CASH • CHECK ■ =SW■
SUBTOTAL
0 .00
•
PLUS PROCESSING
FEE
$35.00
DATE:
FAXED PERMITS WILL ONLY BE ACCEPTED
OF A MAJOR CREDIT
xv xFc.
WITH PAYMENT
CARD
TOTAL PERMIT FEE
DUE
K°
BANRCARD NUMBER:
AUTHORIZED SIGNATURE: