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�i 1 r vr �xvlv� H.rrLic,t�1 ivlv r�tc��t�vit;�r�tc�vtt 1 Yage 2.�f� - <br /> COOLING SYSTEMS <br /> ����� l <br /> Make: �G��1-�``�- <br /> � <br /> Model: xP]lc5-Ol�_ 23i-• <br /> Tons: �' <br /> H.Power <br /> ��REPLACES <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 recalculating cfm <br /> No. Bath Exhaust(mus- t iave duct outs�de) cfm <br /> No. Other Fans: Locations �� <br /> FUEL STORAGE(MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation or Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> �ERNIIT FEE CALCULATION(S) <br /> 2002 State Statute Yes This Section Applies <br /> �he 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) as a total cost of$500.00 or less;excluding the cost of the fiarture or appliance: <br /> and <br /> 3) Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip ne�ct section; Cost of Permit $ 15.00 <br /> State Surcharge$ <br /> Mail-In Fee $ l. <br /> a ove oes not app y, o ow gui e mes e ow: <br /> 1. Contract Price* is .O125%of job with a Minimum Fee of($35.00) <br /> ------ Z�c��% � x.0125 $ ��.� .���"� <br /> (contract price) (minimum 535.00) <br /> 2. State Surcharge. ** Add fl�e State Building Code Division a Minimum Fee of($.50) <br /> ZI $(�`� x.0005 $ ��� � <br />