2004, 07-08 Permit App: BLD-04-07034 AC a'1°cE R 4
S { ae
l 90 34
MECHANICAL PERMIT APPLICATION
ROJECT . 4 ( 0 J S w S U N cQ.e 11! PERMIT /
ADDRESS: I. (aYl USE: � e(,J �-/ C u (/t.t
OWNER: !� f .-.f� 0 J a will t a.� PHONE Daytime Contact): ll
MAILING ADDRESS: VI 0 .) S., S� -ea LaV("\ —CPC/ea
a� r (-A . 9fg(Q�
(street) (city/state)�u v -(zip)
CONTRACTOR: LICENSE#:
Z d- Gg GUN( AIC �r3Gl--.E 5t`CS m3 I3CHFt rtt DUO 3/2
MAILING ADDRESS: 'PHONE#:
q-13-7—)'I'6 ( .
(street) (city/state) (zip)
DESCRIPTION OF WORK #t or UNITS x COST SOUKS AMOUNT
FUEL BURNING APPLIANCE =017(.0 00,000 X $15 =
•
$50
$100
.
FUEL BURNING APPLIANCE >100,000 X $19
UNLISTED APPLIANCE(ADDITIONAL FEE) =OR<400,000 X
UNLISTED APPLIANCE ADDITIONAL FEE) >400,000 X =
USED APPLIANCE(WSEC min.AFUE rating) =OR.400,000 X $50 =
USED APPLIANCE SEC mitt AFUE retia, >400,000 X $100 =
BOILER/REFRIGERATION 1-100M BTU $15
BOILER/REFRIGERATION 101-SOON BTU $28
BOILER/REFRIGERATION 501-1,000M BTU $39
10 BOILER/REFRIGERATION 1001-1,750M BTU $57
1111
BOILER/REFRIGERATION +1750M BTU $HS =
GAS LOG;GAS INSERT,GAS FIREPLACE - MN
111111
$10 _
RANGE -
$10
DRYER - 111.11111111111113 $10 a 111111111111111FUEL BURNING WATER HEATER - $10
16 MISCELLANEOUS FUEL BURNING APPL - $10 =
17 GAS PIPING(es.Outlet) - $1 a
18 DUCT SYSTEMS - $10
19 VENTILATING FANS - $10 _
III
20 AIR HANDLER JDOES NOT include ducting) =OR<10,000CFM $12 =
21 AIR HANDLER(DOES NOT Include ducting) >10,000CFM $19 a
22 EVAPORATIVE COOLERS - $10 a
®TYPE I HOOD - $50 =
FpTYPE II HOOD
HEAT PUMP/AIR CONDITIONER 0-3 TON / Ell $12$10
E0 AIR CONDITIONER 3-15 TON ` S20 a
27 AIR CONDITIONER 15-30 TON X $25 $
28 AIR CONDITIONER 30-50 TON X $35 a
29 AIR CONDITIONER +50TON X $60 =
30 LPG STORAGE TANK - X $10 a
31 WOOD OR PELLET STOVE/INSERT - X $10 a
32 WOOD STOVE-FREE STANDING - X $25 a
SUBTOTAL / �_
0 CASH 0 CHECX 0 111111111111111 0 ...„
FAXED PERMITS WILL ONLY BEACQEPTED WITHPATM-ENTPLUS PROCESSING $35.00
OF A/AMOR CREDIT CARD FEE
I TOTAL PERMIT FEE
DATE: EXPIRES:l_ DU6
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: