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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: