2005, 07-19 Permit App 05002442 FurnaceCONTRACTOR:
ETPI C)€rc4 PIU S
MAILING ADDRESS:
MECHANICAL PERMIT APPLICATION
PROJ
ADDRESECTS: 11 c_O 3 E. {�6r oo-cl 000,..43
OWNER: f bebbi2 rjitie
iIIS
MAIUNG ADDRESS:
111203 F. PJCb'
(street)
1540(0 E. Sproque
(street)
DESCRIPTION OF Wray
1 'FUEL BURNING APPLIANCE
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
FUEL BURNING APPLIANCE
UNUSTED APPLIANCE (ADDITIONAL FEE)
UNUSTED APPLIANCE (ADDITIONAL FEE)
USED APPUANCE(WSEC min. AFUE rating)
USED APPLIANCE(WSEC min. AFUE rating)
BOILER/REFRIGERATION
BOILER/REFRIGERATION
BOILER/REFRIGERATION
BOILER/REFRIGERATION
BOILER/REFRIGERATION
GAS LOG; GAS INSERT, GAS FIREPLACE
RANGE
DRYER
FUEL BURNING WATER HEATER
MISCELLANEOUS FUEL BURNING APPL
GAS PIPING (ea. Outlet)
DUCT SYSTEMS
VENTILATING FANS
AR HANDLER (DOES NOT include ducting)
AIR HANDLER (DOES NOT Include ducting)
EVAPORATIVE COOLERS
TYPE I HOOD
TYPE II HOOD
HEAT PUMP/AIR CONDmONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
LPG STORAGE TANK
WOOD OR PELLET STOVE/INSERT
WOOD STOVE - FREE STANDING
D CASH D CHECK ❑ - 0
FAXEDPERbII1SWILLONLYBEACCEPTEDWITHPAYlc4ENT
OF A MAJOR CREDIT CARD
OS- 2yH
,41 5 -7 tfoJ
PERMIT
USE: �u r it Cticc / U 2 O
PHONE (Daytime Contact);
_ 2 14- q JG
(city/state) •(z (zip)
LICENSE #:
PHONE #:
EFFIGPHg9 .r T 7
926—y000
'erG4r,..1e r co.A cg2!e,
(city/state'
= OR<100,000
>100,000
OR<400,000
>400,aao
0R<400,000
>400,000
1-100M BTU
101-500M STU
501-1,000M BTU
1001-1,750M BTU
+1750M BTU
=OR<10,000CFM
>10,000CFM
0-3 TON
3-15 TON
15-30 TON
30-50 TON
+50TON
DATE: EXPIRES:
BANXCARD NUMBER:
AUTHORIZED SIGNATURE:
# OF UNIT$ X COST
X $15
X $19
X $50
X $100
X $50
X $100
X $15
X $28
X $39
X $57
X $95 =
x $10 =
X $10
X $10 =
X $10 =
x $10 =
X $1 _
X $10 =
X $10 =
X $12 =
X $19
X $10
X $50
X $10 =
X . $12 =
X $20 =
X $25
x $35
X $60
$10
. $10
$25
=
PLUS PROCESSING
FEE
TOTAL PERMIT FEE
DUE
(zip)
EQUALS
AMOUNT
!17;
7
5.0
$35.00
(o0.00