2004, 08-27 Permit App: BLD-04-07497 Mechanical FixturesMECHANICAL PERMIT APPLICATION
PROJECT
ADDRESS: •
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PERMIT / t ,�/ J
USE: &Q.i Wc/ Z Aft-' a) [k/�1reV'i
OWNER: part
PHONE (Daytime C00L$ t):
MAILING ADDR
SS: j(/ E Y7 ra— gip 01[w (/J . 9F-2.0 2O d(c)
(street) Seity/State) • (zip)
CONTRACTOR
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LICENSE #:
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MAILING ADDRESS:
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PHONE $:
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(street) (city/state) (zip)
BANXCARD NLIMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
#OF DIM
X
COST
EMU
AMOUNT
1 FUEL BURNING APPLIANCE
• DR<100,000
X
$15
•
2 FUEL BURNING APPLIANCE
'100,000
X
$19
•
3 UNLISTED APPLIANCE(ADDITIONAL FEE)
•OR<400,000
X
$50
-
4
5
UNLISTED APPLIANCE (ADDITIONAL FEE)
.400,000
X
1100
-
USED APPLIANCE(WSEC min. AFUE rating)
•084400,000
X
$50
-
6 USED APPLlANCE(WSEC min. AFUE retin9L
.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
157
11 BOILER/REFRIGERATION
41750M BTU
X
$95
-
12 GAS LOG•, GAS INSERT, GAS FIREPLACE
-
/ .,
%
110
=
/0 ,OD
13 RANGE
-
X
' , *10
•
14 DRYER
-
X
• $10
15 FUEL BURNING WATER HEATER
-
X
$10
-
15MISCELLANEOUS FUEL BURNING APPL
-
(
X
$10
=
/0 ,pi
17 GAS PIPING (ea. Outlet
•
2
X
$1
io
2-
18 DUCT SYSTEMS
-
X
$10
=
19 VENTILATING FANS
-
X
$10
•
20 AIR HANDLER (DOES NOT Include ducting)
•OR<10,000CFM
X
112
-
21 AIR HANDLER (DOES NOT Include duotny)
>10,000CFM
X
$19
=
22 EVAPORATIVE COOLERS
-
X
$10
•
23 TYPE I HOOD
•
X
$50
=
24 TYPE U HOOD -
-
X
$10
25 HEAT PUMP/AIR CONDITIONER
0-3 TON
X
, .112
•
28 AIR CONDITIONER
3-15 TON
X
$20
-
27 AIR CONDITIONER
1540 TON
X
$25
•
28 AIR CONDITIONER
30-50 TON
X
$35
-
29 AIR CONDITIONER
a50TON
X
$80
•
30 LPG STORAGE TANK
-
X
$10
•
31 WOOD OR PELLETSTOVERNSERT
-
X
'. $10
=
92 WOOD STOVE - FREE STANDING
-
X
825
-
p
twit.
'
CASH ElclscK El
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SUBTOTAL
'010
r
PLUS PROCESSING
FEE
$35.00
mI2HPAYSfeM
WD
CARD
TOTAL PERMIT FEE_O
DUE
a
BANXCARD NLIMBER:
AUTHORIZED SIGNATURE: