2004, 03-23 Permit App: BLD-04-03852 Furnace, Pipingd1'F dE
a&'
40.0 Valley
PROJECT '"') /
ADDRESS: S [ V/ t-- (NUhD Ler
DESCRIPTION OF WORK
PERMIT, /
USE: �ei(J'C.4 'h�MtC� --
OWNER:IA t( �. p 0 2.
X
PHONE tDa me Contact):
MAIUNG ADDRES Si / ( E
,,
I O U OC. -v Of/0
�
��. F92( t
(street)
V
Salty/state)
(
• (zip)
CONTRACTOR:
3 It C 41 c4 &
C
`S . 0 3
LICENSE #:
13C -646-
tt,n3_— acHER1}eDoc RA
MAILING ADDRESS:
fg4G`L E. ccci-t fat,
S &o.Kc is
PHONE*:
1) q
p p _pr_rrtz 1
wA-
'Rz II 6
=OR<400,000
(street)
(city/state)
350
(zip)
DESCRIPTION OF WORK
9 or UNm
X
COST
EQUALS
AMOUNT
- 1
FUEL BURNING APPLIANCE
• OR<100,000
(
X
$15
a
`S . 0 3
2
FUEL BURNING APPLIANCE
>100,000
X
$19
=
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
=OR<400,000
X
350
'
.4
UNUSTED APPLIANCE (ADDITIONAL FEE)
>400,000
X
3100
a
5
USED APPLIANCESWSEC mtn. AFUE rating
.OR<400,000
X
350
a
6
USED APPLIANCE(WSEC min. AFUE rating)
>400,000
X
3100
•
7
BOILER/REFRIGERATION
1-100M BTU
X
315
a
8
BOILERIREFRIGERATION
101500M BTU
X
• $28
•
9
BOILERIREFRIGERATION
501-1,000M BTU
X
339
•
10
BOILER/REFRIGERATION
1001-1,750M BTU-
X
357
a
11
12
BOILER/REFRIGERATION
+1750M BTU
X
$95
a
GAS LOG GAS INSERT, GAS FIREPLACE
-
.,
X
310
=
13
RANGE-
X
' $10
=
14
DRYER
-
X
- 310
.
15
FUEL BURNING WATER HEATER-
X
$10
a
16
MISCELLANEOUS FUEL BURNING APPL-
X
$10
.
17
GAS PIPING (ea. Outlet)
-
1'X
$1
18
DUCT SYSTEMS-
X
$10
•
19
VENTILATING FANS-
X
$10
=
20
AIR HANDLER (DOES NOT Include ducting)
aOR<10,000CFM
X
312
a
21
AIRHANDLER (DOES NOT Include ducting)
>10,000CFM
X
$19
=
22
EVAPORATIVE COOLERS
-
X
$10
' a
23
TYPE IHOOD-
X
350
a
24
TYPE II HOOD-
X
$10
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
. $12
a
26
AIR CONDITIONER
3-15 TON
• X
$10
.
27
AIR CONDITIONER
15-30 TON
X
325
a
28
AIR CONDITIONER
30-50 TON
X
$35
a
29
AIR CONDITIONER
.+50TON
X
360
30
LPG STORAGE TANK-
X
310
•
31
WOOD OR PELLET STOVE/INSERT-
X
. $10
=
32
WOOD STOVE • FREE STANDING-
X
$25
.
❑
DATE:
• •
41S
VITH PAYgill4r
CAW
SUBTOTAL
`G, Ov'
CASH ❑CHECK IN 0
PLUS PROCESSING
FEE
$35.00
'AXED PBADmTSWILL ONLYDRA
OP A MAJOR. =WIT
- EXPIRES:
TOTAL PERMIT FEE
DUE
S Oa
BANXCARD NUMBER:
AUTHORIZED SIGNATURE: