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2004, 07-15 Permit App: BLD-04-07070 Mechanical Fixtures
*Wane� MECHANICAL PERMIT APPLICATION PROJECT u 1 ¢ ADDRESS: i l7 i i t I. S� j j, Sf �� PERMIT jo USE: COI �t=`) C '`- PHONE (Daytime Coiitas ;: > t, ( / : , OWNER: ' ( t Ufa co, MAILING ADDRESS: 1 I S" , C.. -re/ a to‘,4 , 1 (street) (city/state) ti'` (zip) CONTRACTOR: Z �- G j4f atr'�a Al C $15 = LICENSE #: 14104 -E prii3tos - au / CI�.FA6-e baa iTi� MAILING ADDRESS: 1C c1 E. c c‘kr,k1014 >100,000 PHONE #: q— p 3 j $19 S P Kctvne wd - 'pg216 UNLISTED APPLIANCE (ADDITIONAL FEE) (street) (city/state) (zip) BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION OF WORK * or UNITS X COST EQUALS AMOUNT 1 FUEL BURNING APPLIANCE WOR<100,000 X $15 = FUEL BURNING APPLIANCE >100,000 $19 = UNLISTED APPLIANCE (ADDITIONAL FEE) =OR<400,000 >400,000 =OR<400,000 IX X $50 $100 $50 = = = © UNLISTED APPLIANCE (ADDITIONAL FEE) 111 USED APPLIANCE(WSEC mitt AFUE rating) USED APPLIANCE SEC min. AFUE rating) BOILER/REFRIGERATION >400,000 . X $100 = _ i 0. - _ 1127 BOILERIREFRIGERATION1001-1,750M BOILER/REFRIGERATION , is - . : _ _ _ 13 GAS LOQ; GAS INSERT, GAS FIREPLACE . _ RANGE • a DRYER FUEL BURNING WATER HEATER alli. :I ® = GAS PIPING (ea. 16IX DUCT SYSTEMS IIIMIHNIEBINIMMIll ' VENTILATING FANS $10 = AIR HANDLER(DOES NOT Include ducting • - + . $12 = 21 AIR HANDLER (DOES NOT include ductan 10,000CFM $19 = 22 EVAPORATIVE COOLERS • 23 TYPE iHOOD Mil s 24 TYPE II HOOD 25 HEAT PUMP/AIR CONDITIONER • • AIR CONDITIONER 3-15 TON 27 AIR CONDITIONER , 28 AIR CONDITIONER 30-50 TON $35 29 30 AIR CONDITIONER LPG STORAGE . • - - $60 111111111111111 1111131111 = 31 TANK WOOD OR PELLET STOVE/INSERT X $10 X $10 32 WOOD STOVE - FREE STANDING - X $25 = • 0 DATE: SUBTOTAL : CASH ■ CHECK ❑aiiiii 0 PA7 Dpazuersanza,OM.?asACamavrrxPAYNTEN OF AMAJOR ca DrrCARD EXPIRES: FLUS PROCESSING FEE $35.00 IDUE TOTAL PERMIT FEE 1 BANKCARD NUMBER: AUTHORIZED SIGNATURE: