2003, 12-19 Permit App: BLD-03-03316 Mechanical FixturesSCY"'F UE op
arte
.00.10Valley
MECH
PROJECT ADDRESS:
ADDRESS: /_ P L. C1
....
.
t 0
,
PERMIT .. e .. ,.,.
USE: l I ti c 3 /,
y
L--�1.
COST
, EQUALS
1!
OWNER: Az
FUEL BURNING APPLIANCE
PHONE (Daytime Con •ct):
$15
MAILING ADDRESS:
4
.42 4'.4 � Z .� , Wil. .►i/
ci /state
• zl
2
/
Y
street
CONTRACTOR: S
APPLIANCE (ADDITIONAL FEE)
-OR<400,000
LICENSE #:
PHONE #:
ccs 41'.4' I
Q $50
-
4
MAILING ADDRESS:
/41.1(/ E. cc-k-ttic
S P0,Ket.(71-'
u)4- 'g216
(01y/state)
(zip)
-
5.4
USED APPUANCE(WSEC min. AFUE rating)
(street)
EA.NRCAItD NUMBER:
AtITORIZED SIGNATURE:
DESCRIPTION OF wow
*OPO ars
COST
, EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
= OR'100,000
$15
2
FUEL BURNING APPLIANCE
>100,000
$19
Y
3 UNLISTED
APPLIANCE (ADDITIONAL FEE)
-OR<400,000
Q $50
-
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
>400,000
X $100
-
5.4
USED APPUANCE(WSEC min. AFUE rating)
'OR<400,000
X
$50
I,
6
7
USED APPLIANCE(WSEC min. A 1J.E rating)
>400,O00
X
$100
=
BOILER/REFRIGERATION
1-100M BTU
101-500M BTU
X
X
$15
$28'
-
-
BOILER/REFRIGERATION
9
BON.ER/REFR.IGERATION
501-1,000M BTU
X
$39
=
10
BOILER/REFRIGERATION
1001-1,750M BTU
X
$57
OILER/REFRIGERATION
1
B1
+1T50M BTU
X
$95
•
12
13
GAS LOG, GAS INSERT, GAS FIREPLACE
-
X
$10
=
RANGE-
-
X
X
$10
31---- 5
-
14
DRYER
-
--- =
_
/a
15
FUEL BURNING WATER HEATER
-
X
$10
16
MISCELLANEOUS FUEL BURNING APPL
-
X
$10
=
17
GAS PIPING (ea. Outlets
-
3
X
X
$1
$10
_
=
18
DUCT SYSTEMS
19
VENTILATING FANS
-
X
*10
-
20
AIR HANDLER (DOES NOT include ductin
-ORO0,000CFM
X
$12
21
AIR HANDLER (DOES NOT include ducctln)
>10,000CFM
X
$19
=
22
EVAPORATIVE COOLERS
-
X
$10
s
23
TYPE I HOOD
-
X
_ $50
-
2
TYPE Il HOOD
- r
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
2
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
Q
0
na
•.i
=
SUBTOTAL
-. -
CASH 0 CHECK i 0
I
PLUS PROCESSING
FEE
$35.00
FAXED PEbtbIITSOWTLL OR GRED rrecCARw r P.vaerrr
m FYPTS/VS
TOTAL PERMIT FEE
DUE .....
`„/ (mss
��d_
EA.NRCAItD NUMBER:
AtITORIZED SIGNATURE: