2004, 01-14 Permit App: BLD-04-03404 Gas PipingaTl c +/,
Sp+o'� ime
Mechanical Permit Application
11707 East Sprague Ayenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT Ni
ADDRESS: 1 gV ' 6D(,01 ,
h
PERMIT
USE:
9 OF UNITS
OWNER 12 j m "y'i cli, f
jl/ bOk)1
PHONE (Daytime Contact): 455_ e(Q Q D
MAILING ADDRESS: , )4/ 43at '
-.'1 CaoK.44
`'I D •R1 rY1 rrectnet_ - John ,e /S-4° 14-1/411e, wA-�'RG
(street) (city/state)
(ZIP)
CONTRACTOR:
LICENSE 11:
515
MAILING ADDRESS:
PHONE #:
FUEL BURNING APPLIANCE
> 100,000
(street)
(city/state)
(ZIP)
METHOD OF PA
❑ CASH C
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
9 OF UNITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
= OR < 100,000
X
515
=
2
FUEL BURNING APPLIANCE
> 100,000
X
$19
=
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
= OR < 400,000
X
550
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
> 400,000
X
$100
-
5
USED APPLIANCE (WSEC min. AFUE rating)
= or < 400,000
X
$50
-
6
USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
5100
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
515
=
8
BOILER/REFRIGERATION
101- 500M BTU
X
$28
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
$39
=
10
BOILER/REFRIGERATION
1001 - 1,750M BTU
X
$57
=
11
BOILER/REFRIGERATION
+1750M BTU
X
$95
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
X
$10
=
13
RANGE
-
X
510
=
14
DRYER
-
X
$10
15
FUEL BURNING WATER HEATER
--
X
$10
=
16
MISC FUEL BURNING APPL.
-
X
510
=
17
L.
GAS PIPING (ea. Outlet) Y W�
-
1
X
$1
-
18
DUCT SYSTEMS (�
-
X
$10
=
19
VENTILATING FANS
-
X
$10
=
20
AIR HANDLER (DOES NOT include ducting)
= OR < 10,000CFM
X
$12
=
21
AIR HANDLER (DOES NOT include ducting)
> 10,000 CFM
X
$19
=
22
EVAPORATIVE COOLERS
-
X
510
23
TYPE I HOOD
-
X
$50
=
24
TYPE II HOOD
-
X
$10
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$12
=
26
AIR CONDITIONER
3-15 TON
X
$20
27
AIR CONDITIONER
15-30 TON
X
525
=
28
AIR CONDITIONER
30-50 TON
X
$35
=
29
AIR CONDITIONER
+50 TON
X
$60
-
30
LPG STORAGE TANK
-
X
$10
=
31
WOOD OR PELLET STOVE/INSERT
-
X
$10
=
32
WOOD STOVE - FREE STANDING
-
X
$25
=
MENT
}
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: