2003, 09-04 Permit App: BLD-03-02379 ACSficikane
MECHANICAL PERMIT APPLICATION
PROJECT _
ADDRESS: 50 ' . S ‘26..)0/1-1/1
OWNER: , n
DESCRIPTION OF WORK
PERMITTR----7
AiY)
USE: '�I tl✓ 00
# OF UMTS
PHONE (Daytime Contact}:
G, ���
MAILING ADDRESS: f. SPij� O 6 i CC' l� �l 7 v J 2.__
street) (ci Istaie) {zip)
CONTRACTOR:
C C. c -A
C
LICENSE #:
f3Cq-.6.660M; 613 -- acHEi3 9-eOCkei2
PHONE #: rl 60 pp► f
MAILING ADDRESS:
12±.(_4( Z - C .-
(stree)
4- 1 Qi 2 [ 6
(city/state_ (zip)
BANKCARD NUMBER:
AUTHORIZEZ1 SIGNATURE:
DESCRIPTION OF WORK
# OF UMTS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
- OR<100,000
X
$15
•
2
FUEL BURNING APPLIANCE
>100,000
X
$19
=
3
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
-OR<400,000
X
$50
-
UNLISTED APPLIANCE SADDrONA FL----..
>400,000
=OR<400,000
X
X
$1 00
$50
=
5
6
7
USED PPLCE(WSEC trip. AFUE raf4n�
SAIAN(Win. AFUE rating)
USED APPLIANCE SEC m
BOILER/REFRIGERATION
>400,000
1-100M BTU
X
$100
JX
X
$15
$28
8
BOILER/REFRIGERATION •
101-500M BTU 4
9
BOILER/REFRIGERATION
501-1,000M BTU
X
$39
10
BOILER/REFRIGERATION
1001-1,750M BTU
-
X
$57
-
11
BOILER/REFRIGERATION
+1750M BTU
X
$95
12
GAS LOG GAS INSERT, GAS FIREPLACE
-
X
$10
13
RANGE
- t
$10
14
DRYER
-
X
$10
15
_
FUEL BURNING WATER HEATER
-
X
$10
18
MISCELLANEOUS FUEL BURNING APPL
-
X
$10
17
GAS PIPING (ea. Outlet}
-
-
X
X
$1
$10
tt
•
18
DUCT SYSTEMS
19
VENTILATING FANS
-
r
X
$10
=
20
AIR HANDLER DOES NOT-OR<10,000CFM
X
$12
21
AIR HANDLER•
>10,000CFM
X�
X
=
22
'1' COOLERS
`$19
$10
-
23
TYPE I HOOD
-
x
550
=
24
TYPE 11 HOOD
-
x
$10
-
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
/
X
. 512
26
AIR CONDITIONER
3-15 TON
X
520
27
AIR CONDITIONER
15-30 TON
X
525
28
AIR CONDITIONER
30-50 TON
X
535
-
29
AIR CONDITIONER
+50TON--,
X
580
-
30
LPG STORAGE TANK -
-
X
$10
-
,
31
WOOD OR PELLET STOVE/INSERT
-
X
. $10
-
32
WOOD STOVE - FREE STANDING
-
X
$25
-
�""
_ _.. �-
0 CASH 0 CHECK 0 = 0 !
FA XLD pars WILL, ONLY BE ACCEPTED virrH PAYR Wr
OF A MAJOR CREDIT CARD
SUBTOTAL
PLUS PROCESSING
FEE
$35.00
TOTAL PERMIT FEE
DUE
ti--) ilk
7
BANKCARD NUMBER:
AUTHORIZEZ1 SIGNATURE: