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2003, 04-18 Permit App: BD03-076 Mechanical Fixtures ocrTt` * td- 3 MECHANICAL PERMIT APPLICATION PROJECT e. I a _ PERMIT c f / ADDRESS: L �J ) L� F I USE: U W r I r4tCF' /k-C Luc, ! 4 t'Cly� OWNER: P� 1—f l C k©tA c PHONE(Daytime`" Contact): 9 s� ll _ 0 .30 MAILING ADDRESS: �[ ce (street) (city/state) gz(zip) CONTRACTOR: C- " � LICENSE#: MAILING ADDRESS: PHONE#: • (street) (city/state) (zip) DESCRIPTION OF WORK #OF OMITS X COST EQUALS AMOUNT 1 FUEL BURNING APPLIANCE =OR<100,000 / X $15 = /6- 2 52 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) =0R<400,000 X $50 = 6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 = 7 BOILER/REFRIGERATION 1-100M BTU X $15 = 8 BOILER/REFRIGERATION 101-500M BTU X $28 = 9 BOILER/REFRIGERATION 501-1,000M BTU X $39 = 10 BOILER/REFRIGERATION 1001-1,750M BTU X $57 = 11 BOILER/REFRIGERATION +1750M BTU X $95^ = 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 PIPING(ea.Outlet) - X $1 = 16 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 = 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 = / :2- 26 Z26 AIR CONDITIONER 3-15 TON X $20 = 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 = 31 WOOD OR PELLET STOVE/INSERT - X , $10 = 32 WOOD STOVE-FREE STANDING - X $25 . = -- I SUBTOTAL 00 ❑ CASH ❑ CHECK 0 111111111111111 0 FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT PLUS PROCESSING $35.00 OF A MAJOR CREDIT CARD FEE TOTAL PERMIT FEE !y1 DATE: EXPIRES: DUE j: 72 t'v BANKCARD NUMBER: b • AUTHORIZED SIGNATURE: