2004, 06-25 Permit App: BLD-04-04715 ACc1T4 OF 0�►
Sl3{ e
ey
MECHANICAL PERMIT APPLICATION
PERMIT t ^�t []��
USE: (�/ � c
PHONE (Da ontact): ?
SPOT PLe_ Uc�O ("44-. X637
(city/state) (zip)
LICENSE #:
FIGS g"l` gt*C 613 +3ce4 fi a -e doer gA
PROJ
ADDRECESS: T (i'C J 7 c4A4,0
t�
OWNER:
MAILING ADDRESS:
CONTRACTOR:
-MAILING ADDRESS:
`(0/07 C c c
(street)
c -Ad A'[c
PHONE #:
f CI - sPKc vie L04- /q 2 1 6
(city/state) (zip)
(street
DESCRIPTION OF WORK
0 or UNITS
x
COST
EQUALS f AMOUNT
1
FUEL BURNING APPLIANCE
2
FUEL BURNING APPLIANCE
• OR<100,000
>100,000
X
$15
X
$19
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
=OR<400,000
X
$50
4
UNLISTED APPLIANCE (ADDITIONAL. FEE)
>400,000
X
$100
5
USED APPUANCE(WSEC min. AFUE rating) 1-OR<400,000
X
*50
6
USED APPUANCE(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
*57
11
BOILER/REFRIGERATION
+1750M BTU
$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
16
MISCELLANEOUS FUEL BURNING APPL
$10
17
GAS PIPING (ea. Outlet)
$1
18
DUCT SYSTEMS
X
$10
19
VENTILATING FANS
$10
20
AIR HANDLER (DOES NOT include dueling) 1-OR<10,000CFM
$12
21
22
AIR HANDLER (DOES NOT include ducting) .
'EVAPORATIVE COOLERS
>10,000CFM
x
$19
X
$10
23
TYPE I HOOD
X
$50
24
TYPE 11 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,
_
-
8
-
se
_
❑ CASH ❑ CHECK 0 0
FAXED PERMITS WILL ONLY SE ACCEPTED WITH PATIWENT
OF A MAJOR CREDIT CARD
DATE: EXPUtES:
BANRCARD NUMBER:
AUTHORIZED SIGNATURE:
SUBTOTAL
co
PLUS PROCESSING
FEE
!TOTAL PERMIT FEE
DUE
$35.00
'Roo