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�i i r vr �xvlvv HrrLic,�i ivi� r utc rn��n�vi�At,r�tcNu i Yage 2 ..a <br /> COOLING SYS'TEMS A <br /> Quantity: / <br /> Make: ���"V�`' :. '�, <br /> Model: C ����,� �P�������i <br /> Tons: ���l <br /> H.Power <br /> FIREPLACES <br /> ---_ <br /> Gas factory fire 1 —— <br /> Wood b ' g factory fireplace with flue <br /> W _ �tove------ -. <br /> � ood stove with flue <br /> i <br /> Brand Name Mode]No. <br /> VENTILATION <br /> - No. Kitcli�n-��haust duct recalculating cfm <br /> No. Bath Exhaust(must have duct outside) cfm <br /> No. Other Fans:I.�cations �� <br /> FUEL STORAGE(MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation or Removal <br /> Fuel oil: �allons underground inside outside <br /> LP Gas: ---gallons _ . . <br /> Other � Gas opening <br /> PERNIIT FEE CALCULATION(S) <br /> 2002 State Statute Yes This Section Appties <br /> "Ihe replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> l) 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 ftxture 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$ .50 <br /> Mail-In Fee $ 1.50 <br /> I�v�not apply, o low gui e ines e ow: <br /> I. Coniract Price* is .0]25% of joU with a Minimum Fee of($35.00) ��_ <br /> -�-------- � � ��.�-- x.0125 $ l./ <br /> _- ----- ------ _ ---------- ._ <br /> (contract price) (minimum$35.00) <br /> 2. State Sui-charge. ** Add the State Building Code Divisi�n a Minirnum Fee of($SO) <br /> __.. _ -- , <br /> �i' r ;�j <br /> �' � � x_0005 $ �� _ <br />