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�i t r yr vxvivv ArrLjt A1IVIN rUN.r4V1 AiAN1L;AL Yt;KM 1 Page 2 of 3 , <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name Model No. <br /> VENTILATION <br /> No. Kitchen Exhaust duct recalculatingd-mcfinRe� <br /> No. Bath Exhaustmust have duct outside) cfm C® 1 <br /> No. Other s cfin <br /> FUEL STORAGE(MUS BE APPROVED BY FIRE MARSHAL) f <br /> Installation or Removal <br /> Fuel oil: _gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERM1T FEE CALCULATIONS) <br /> 2002 State Statute Yes This Section Applies <br /> fihe replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1) Does not require modification to electrical or gas service. <br /> 2) Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance: <br /> and <br /> 3) is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section; Cost of Permit $ 15.00 <br /> State Surcharge$ <br /> Mail-In Fee $ <br /> If above does not app follow gut a mes ow: <br /> 1. Contract Price* is .0125%of job with a Minimum Fee of($35.00) <br /> x.0125 $ <br /> (contract price) minitnum$35.00) - — <br /> 2. State Surcharge. ** Add the State Building Code DivisW aM_inimam Fee of(S.50) <br /> --- �7 x.0005 $ <br />