2003, 01-01 Permit App: BD-03-022 Water Heatercnr #0 \ a
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.0,0Valley
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MECHANICAL PERMIT APPLICATION
80 o3-bZa
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PROJECT
ADDRESS:
2�-��/j
�,
PERMIT
USE:
OWNER: ,o_
COST
_A '9
PHONE (Daytime Contact): v, z , 3 R/
MAILING ADDRESS:
FUEL BURNING APPLIANCE
= OR<100,000
X
(street) (city/state) (zip)
CONTRACTOR:`
s
LICENSE #:
Sa s 9g Y.(
4 �'`'� �
MAILING ADDRESS:
2?C7
, ILegyL--
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r
,P6
PHONE #:
.los L‘ V.-06 V 9
(2- ix gig/K
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
(street) (city/state) (zip)
•
BANKCARD 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)
=OR<400,000
X
$50
=
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
>400,000
X
$100
=
5
USED APPLIANCE(WSEC min. AFUE rating)
=OR<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 1
X
$39
=
10
BOILER/REFRIGERATION
1001-1,750M BTUX
$57
=
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
=
/10< r
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)
=OR<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 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
. =
-I i
L .:L. -
WITH PAYI ENT
CARD
SUBTOTAL
• CASH gl CHECK • .• •
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS WILL ONLY BE ACCEPTED
OF A MAJOR CREDIT
T A c. r VDT rC.
TV
TOTAL PERMIT FEE
DUE
i�
•
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: