2004, 07-08 Permit App: BLD-04-07036 Mechanical Fixtures pr Or irkam:01.1.11 114144 141.111.1
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4000 Valley
MECHANICAL PERMIT APPLICATION
'PROJECT tr /� E PERMIT �1
ADDRESS: j O R LI -U USE: pet,,,, (-z-vcac j 11 4- ()T -c,
OWNER: Oy c� (.e ((ey PHONE(Daytime Contact): ��
MAILING ADDRE S: Z 0,5—
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(street) (city/state) (zip)
CONTRACTOR: LICENSE#:
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MAILING ADDRESS: PHONE#:
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(street) (city/state) (zip)
DESCRIPTION OF WORK #OF wars X COST _ EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR100,000 i_ X $15 a 2S,coO
2 FUEL BURNING APPLIANCE >100,000 ' X $19 =
3 UNLISTED APPLIANCE(ADDITIONAL FEE) =OR<400,000 X $50 -
or
4 UNLISTED APPLIANCE ADDITIONAL FEE) >400,000 11.11110.01 $100 r
5 USED APPLIANCE_(WSEC min.AFUE rating) =OR-400,000 $50 =
6 USED APPLLANCE(WSEC min.AFUE rating) >400,000 $100 =
7 BOILER/REFRIGERATION 1-100M BTU $15 =
8 BOILER/REFRIGERATION 101-500M BTU S28 =
9 BOILER/REFRIGERATION 501-1,000M BTU X MO=
10 BOILER/REFRIGERATION - 1001-1,750M BTU X
11-BOILER/REFRIGERATION +1750M BTU X $95�
12 GAS LOG;GAS INSERT,GAS FIREPLACE - X $10 =
13 RANGE - X $10 a
14 DRYER - X $10 a
15 FUEL BURNING WATER HEATER - X $10 =
..
16 MISCELLANEOUS FUEL BURNING APPL - I X $10 =
17 GAS PIPING(ea.Outlet) .. X $1 = d
-
18 DUCT SYSTEMS - / X $10 = /0 \e
•
19VENTILATING FANS - X $10
20-AIR HANDLER(DOES NOT include ducting) , =OR<10,000CFM X $12 = _
21 AIR HANDLER(DOES NOT Include ducting) ., >10,000CFM X $19 a
22 EVAPORATIVE COOLERS - X $10 =
23 TYPE I HOOD " - X $50 =
24 TYPE II HOOD - 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 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 =
MM. .
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SUBTOTAL � `
..7: ::„ 26 Lb
0 CASH 0 CIC 0 MEN 0 PLUS PROCESSING
AXED PERMITS WELL OM.Y BE ACCEPTED' MTH PAYMENT $35.00
OF A MAJOR wpm CARD FEE
TOTAL PERMIT FEE
DATE: - EXPIRES:, DUE �l`VU
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: