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2003, 04-04 Permit App BD 03-184MAILING ADDRESS: L€ Valley.11��' �5 o 12 - 21 t 3 iit) 03- s/Li MECHANICAL PERMIT APPLICATION PROJECT 6 ©j / I , Ter/1 hevE USEPER. %1Q G-c- 4XtS' ti ezr i6114�14 CK. ADDRESS: CJ C� rV T OWNER: j PHONE (Daytime Contact): p MAILING ADDRESS: 7 n / 3� (6 C age 46- (street) ) _ (city/state) • (zip.) T 1 G r j 4 LICENSE #: (J �-f ��r s Jri�. d d i r4 a c y re,os.3 vyt 3 -- l3cHH4/314-5(D a0 aiZ PHONE #: DT) 9- .9_) 7 --0-6 f tyv2_6_ c,f-dc() s-p oko/ut A S/ street 1 2 DESCRIPTION OF WORK FUEL BURNING APPLIANCE FUEL BURNING APPLIANCE 3 UNLISTED APPLIANCE (ADDITIONAL FEE) 4 UNLISTED APPLIANCE ADDITIONAL FEE) 5 USED APPLIANCE(WSEC min. AFUE 6 USED APPLIANCE(WSEC min. AFUE 7 BOILER/REFRIGERATION 8 BOILER/REFRIGERATION 9 BOILER/REFRIGERATION 10 BOILER/REFRIGERATION 11 BOILER/REFRIGERATION rating) OR<100,000 >100,000 =0R<400,000 >400,000 •OR<400,000 rating) >400,000 1-100M BTU (city/state) (zip) # OP wars 1 x 1 COST X I $15 X $19 $50 $100 EQUALS' AMOUNT e a X J $50 $100 12 GAS LOG GAS INSERT, GAS FIREPLACE 13 RANGE 14 DRYER 101-500M BTU 501-1,000M BTU 1001-1,750M BTU +1 750M BTU $15 X S28 15 FUEL BURNING WATER HEATER 16 MISCELLANEOUS FUEL BURNING APPL 17 GAS PIPING (ea. Outlet) 18 DUCT SYSTEMS 19 VENTILATING FANS $39 $57 $95 $10 $10 $10 $10 f = $10 s 20 AIR HANDLER (DOES NOT include ducting) =OR<10,000CFM 21 R HANDLER (DOES NOT Include ducting) >10,000CFM 22 EVAPORATIVE COOLERS 23 TYPE I HOOD 24 TYPE II HOOD 25 HEAT PUMP/AIR CONDITIONER 26 AIR CONDITIONER 27 AIR CONDITIONER 28 29 30 31 32 AIR CONDITIONER 0-3 TON 3-15 TON 15-30 TON AIR CONDITIONER LPG STORAGE TANK WOOD OR PELLET STOVE/INSERT WOOD STOVE - FREE STANDING 30-50 TON +50TON Q CASH ❑ CHECK Q Q FAXED PERMITS WILL OPMY SE ACCEPTED WITH PAYAFEM' OP A MAJOR CREDIT CARD DATE: EXP ES: BANrXCARD NUMBER; AUTHORIZED SIGNATURE: $1 $10 $10 $12 $19 $10 $50 $10 $12 $20 $25 $35 $60 $10 $10 $25 ✓ ✓ a SUBTOTAL PLUS PROCESSING FEE TOTAL PERMIT FEE DUE $35.00