2004, 04-16 Permit App: BLD-04-04086 AC104/1J/LU174 F77:DL Dt770J07010
APR 06 2003 12!39 FR
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PERMIT 7» T -4 // J/�
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OWNER: /m t
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PHONE (Daytime Contact): if, 3 _ /?6,..?
$ 1eaA�- ,
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3030E rnIssi6n
PO tett) 4/ (AW 9cc.20
PHONE*
s3 8—w?
.
—
• street)
(city/state) (zf p)
SAN .c,ARD NUMBER:
AUTHORIZEDSIGNATURE:
** TOTAL F'A(iE - 01 **
DUCPJPTION Of WORK
# iniron's
X
COST
FNYALS
AMOI N r
1
FUEL BURNING APPLIANCE
• OR<100,000
X
115
w
_
2
FUEL BURNING APPLIANCE
*100,000
9-
X
$19
-
—�
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
•OR<400.000
X
$50
•
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
*400,000
X
3100
-
—__
S'UBED
AP min. AFUE ragno)
•ORe400.000
*400,000
X
x
$50
' $100
•
Y.
S
LANCc
USED APP C mitt- AFUE rating)
7
90ILER/REt<RIGERAT(ON
1-100M BTU
X
$13
—,
6
TION •
1014500M BTU
X
• $28
■
S
BOILER/REFRIGERATION
S01 -1,000M BTU
1001-1,750M BTU
X
X
$39
• $07
I - -
.7
_
^�
' 10
1r
DOILUWREFRIGERATION -
BOILERIREFRIGfRATION
+17$9M BTU
X
395
•
GAS
LOG GAS INSERT GAS FIREPtAcE
-
•,
X
$10
•
13
GE
-
x
110
M
14
DRYER
-
X
$10
_
—�'
15
P1).....E $URNI G WATER HEATER
- _
X
$10
■
oU8 UEL ANG APDL
- -
X
$10
--
--
17
GAS PIPING (w. Outlet)
-
X
Si
a
16 DUCT
-19
SYSTEMS .__
-
X
$10
•
_ M,
VENTILATING FANS
-
iOR<10,000CFM
X
X
$10
$12-.---=-----
•
--
20'AIR
HANDLER (DOES NOT include duct ng)
21
22
AIR HANDLER (DOES NOT Include duc8ng)
>10,000CFM
X
$19
" •
EVAPORATIVE COOLERS
-
-
X
X
$10
$50
•
_
--
23
TYPE I HOOD
-
24
TYPE II HOOD . -
-
)(
IMO
23
HEAT PUWAIR GONDt ONrR
0-3 TON
3-16 TON
I
)('
X
. }12
$20~
25
AIR DONDITTONEFt , _
•D
_
27
AIR CONDITIONER -
15-30 TON
x
$25
•
2s
AIR CONDITIONER -
30-30 TON
X `
• $35'
•
--,
29
AR COMMONER
. +SOTON
X
$60
a
--
30
31
LPG STORAGE TANK
-
•
X
X
;to
•
-
•
WOOD OR PELLET STOVE/INSERT
WOOD STOVE - FREE STANDING
+
-
r���-""'�"
. i10
-•••-,32
•
X
$25
31:
a
•
SUBTOTAL
�_s#
a
CASH' a mac • 0
PLUS PROCESSING
FES
-
11;38 D3
DATE
TA.xeamuaA'�rutOKTEaACCEPT ACCEPTED
a+AMAWR t
- '
car)
.
CTOTAL
PERMIT FEE
DUE
55.00
SAN .c,ARD NUMBER:
AUTHORIZEDSIGNATURE:
** TOTAL F'A(iE - 01 **