2004, 05-20 Permit App: BLD-04-04400 AC F//t1��F3 �,�Nkos e V
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MECHANICAL PERMIT APPLICATION
PROJECT PERMIT --
ADDRESS: -' • / USE: u f. Iii A . L
OWNER: ti 1 e , OP (Daytime Co :ct): --
MAILING ADDRESS: i ,I �: ,/L,C' 4 ...
!,1 D r-lV 18 I . it . ,
(street (city/state) .(zip)
CONS"f2t— LICENSE*: (,� W
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■ • I '( , l L i4Y 1. it 111 �����k� —1��� (-1MAILING ADDRESS: PHONE#:
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• street cit /state zi•
DESCRIPTION OF WORK #OF wars X COST EOUAI,.s AMOI►N 1'
1 FUEL BURNING APPLIANCE x OR<1 oo,000 X $15 it
2 FUEL BURNING APPLIANCE >100,000 _ X $19 ra
3 UNLISTED APPLIANCE(ADDITIONAL FEE) ■OR<400,000 X $50 ' o
4 UNLISTED APPLIANCE(ADDITIONAL FEE) 5.400,000 X $100 -
5 USED APPUANCE(W$E0 min.AFUE ratln!) •0R<400,000 X $50 ■ _
6 USED APPLIANCE V(�I/SEC min.AFUE rating) >400,000 X $100 _
7 BOILER/REFRIGERATION 1-100M BTU X $15 a
8 BOILERJREFRIGERATION 101-500M BTU X $28 •
9 BOILER/REFRIGERATION _ 501-1,000M BTU X $39 y
10 BOILERIREFRIGERATION 1001-1,750M BTU X $57 , _
11 BOILER/REFRIGERATION +1750M BTU X $95 -
12 GAS LOG GAS INSERT,GAS FIREPLACE - ,, X $10 W
13 RANGE - X $10 •
14 DRYER - X $10 =
15 FUEL BURNING WATER HEATER - X $10 • �r.
18 MISCELLANEOUS FUEL BURNING APPL - X $10 e ——
• 17 GAS PIPING(ea.Outlet) - X $1 #
18 DUCT SYSTEMS _ - X $10 •
19 VENTILATING FANS X $10 a
20 AIR HANDLER DOES NOT Include ducnn mOR<10,(T0Q Fes-' X $12 =
21 AIR HANDLER(DOES NOT Include ducting) >10,000CFM X $19 •
22 EVAPORATIVE COOLERS - X $10 r - •
23'TYPE I HOOD X $50 -"� --
24 TYPE II HOOD - X $10
25 HEAT PUMP/AIR CONDITIONER o-a TON X $12 • L1 ,Cie
25 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 $80
•
30 LPG STORAGE TANK ' �... - X $10
•
31 WOOD OR PELLET STOVE/INSERT - X $10 • —
32 WOOD STOVE-FREE STANDING X $25 .
y MC
T - f SUBTOTAL 1�I 0 t.
0 CASH 0 CEECIC ❑ IiIIIMINN 0 yPLUS PROCESSING
PAXXO Mamas'WILE,ONLY BE ACCEPT=WITH—PAykeNT $35.0,,
OF A MAJOR CREDIT CARD FEE
TOTAL PERMIT FEE
DATE: DUE f-I� b
8ANKCARD Nvkia$R:
AUTHORIZED SIGNATURE:
** TOTAL F'ACE.01 **