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2003, 07-17 Permit App: BLD-03-02047 Piping, Heat Pump ii�4 .d,�'a :00al- \ ley v MECHANICAL PERMIT APPLICATION 'ROkDD E S (kr (f )5. LI PERMIT Jj— �DDRESS: ' ` USE: �"�/ Q� /'� ,�7WNER: rs-14 rf C / C(.tom/,,LI• � yket��„_ PHONE(Daytime Contact): 'i'17S Z� (AILING ADDRESS: Pb (( • t 7 street ewiurt ao Ce) LJ 1©` cVO/4 (street) (city/state) (zip) :ONTRACTOR: --7 LICENSE#: L er 'L.... _-,(Ad 1 .,;. Lt4 i n' tom. `4 ill RCHE e v� : / (AILING ADDRESS PHONE , t, tea.. i, s t- ., 1,--.: 4 `- .;' (street) (city/state) (zip) DESCRIPTION OF WORK #OF wars X COST EQUALS AMOUNT- I FUEL BURNING APPLIANCE =OR<100,000 X $15 = 2 FUEL BURNING APPLIANCE >100,000 X $19 = 3 UNLISTED APPLIANCE(ADDITIONAL FEE) -OR<400,000_- X $50 4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 = 5 USED APPLIANCE(WSEC min.AFUE rating) =OR<400,000 X $50 = 6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 = 7 BOILER/REFRIGERATION , 1-100M BTU X $15 = 8,80ILERIREFRIGERATION- 101-500M BTU X $28 = 9 BOILER/REFRIGERATION 501-1,000M BTU X $39' = 10 BOILERJREFRtGERATtON 1001-1,750M BTU X $57 = 11,BOILER/REFRIGERATION +1750M BTU X $95' = 1 12 GAS LOG,GAS INSERT,GAS FIREPLACE - X $10- = 13 RANGE - X $10 - 14 DRYER X $10 ' - 15 FUEL BURNING WATER HEATER - X $10 = 16 MISCELLANEOUS FUEL BURNING APPL - X $10 = 17.GAS.PIPINa(ea..Cutlet) X $1 ' 3 18 DUCT SYSTEMS - X $10 = 19 VENTILATING 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 = 2TEVAPDRATIVECOOLERS X $10 = 23 TYPE I HOOD X $50 - 24 TYPE It HOOD 25 HEAT PUMP/AIR CONDITIONER 0-3 TON / X $12 = /2, a a 26 AIR CONDITIONER_ 3-15 TON X $20 = ! e 27 AIR CONDITIONER 15-30 TON X $25 = 28 AIR CONDITIONER 30-50 TON X $35 = 29 AIR CONDITIONER +50TON X $60 = 30 LPG STORAGE TANK - - X $10 = 3T WOOD OR PEELET STOVE/INSERT X $10 = 32 WOOD STOVE-FREE STANDING - — X $25 = r SUBTOTAL MIMI 0 CASH 0 CHECK ❑ ❑ _ .' t / v + 610 FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYi .N7 PLUS PROCESSING $35.00 OF A MAJOR CREDIT CARD FEE TOTAL PERMIT FEE DATE: EXPIRES: DU `C'(/r ©V BANKCARD NUMBER. AUTHORIZED SIGNATURE: