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2004, 07-08 Permit App: BLD-04-07035 AC
Sffiikane MECHANICAL PERMIT APPLICATION Rrrnn ADDRESS:POJECT7?O{ - �� ©�Z Y`1 PERMIT USE: 6 c5 -2i1 c. U N r i OWNER: �� 6(Z( C2 6-� PHONE (Daytime Contact): C,; -Z(��2] �. �`��t--? 9 J 1 tied i,Lt. U4 (, J( ' Z7 OJJ 7 MAILING AD KESS: (l�acf `.'AY. S - S6 Q 12 FT (street) city/state) (zip) C NTRACTOR: c" co au'.81 Mc LICENSE #: nG171- 1 2 60c5S i'►'J - ec%>FR of DUu 3/Z PHONE #: C( --p q MAILING ADDRESS: lfLtcz a, Cct (Lcb S P0Kaoi° w4 1q2-16 (street) A City/state) (zip) BANXCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION OF WORK * OF OMITS X COST DUALS AMOUNT 1 FUEL BURNING APPLIANCE = OR•4100,000 X $15 ■ 2 FUEL BURNING APPLIANCE >100,000X $19 = 3 UNLISTED APPLIANCE (ADDITIONAL FEE) =OR<400,000 X_ _ $50 -as 4 UNLISTED APPLIANCE ('ADDITIONAL FEE) >400,000 X $100 = 5 USED APPUANCE(WSEC min. AFUE rating) =OR<400,000 X $50 = 6 USED APPUANCE(WSEC min. AFUE ratin) >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 BOILERJREFRIGERATION 1001-1,750M BTU X $57 c 11 BOILER/REFRIGERATION , +1750M BTU - ., X X $95 + $10 _ = 12 GAS LOG, GAS INSERT, GAS FIREPLACE 13 RANGE - X $10 = 14 DRYER - X 410 = 15 FUEL. BURNING WATER HEATER - X $10 = 16 MISCELLANEOUS FUEL BURNING APPL - X 510 = 17 GAS PIPING (ea. Outlet) - X 51 = 18 DUCT SYSTEMS - X $10 e 19 VENTILATING FANS - X $10 = 20 AfR HANDLER (DOES NOT include ducting) AOR<10,0000FM 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 II HOODX $10 _ 25 HEAT PUMP/AIR CONDITIONER 0-3 TON J X . 512 = 0 V 26 AIR CONDITIONER 3-15 TON r X 420 _ 27 AIR CONDITIONER 15-30 TON X 525 _ 28 AIR CONDITIONER 30-50 TON X *35 _ 29 AIR CONDITIONER +50TON X 560 = 30 LPG STORAGE TANK - X $10 = 31 WOOD OR PELLET STOVE/INSERT - X $10 r = 32 WOOD STOVE - FREE STANDING - X 525. 0 SUBTOTAL CASH 0 CHECK ( ❑ MM. 0 - PLUS PROCESSING FEE $35.00 FAXED ?EMITS WILL ONLY BE ACCEPTED WITH PAYMENT OFA MAJOR CREDIT CARD t.,fl�OU ,te. TOTAL PERMIT FEE DUE ll'� ..,..,.., BANXCARD NUMBER: AUTHORIZED SIGNATURE: