2005, 03-28 Permit App: 05000991 Range, PipingMECHANICAL PERMIT APPEICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, CaII (509) 688-0054
Project Address: ` � �
Owner:
Mailing Address:
`1`71
Community Development Departmen
Building Divisior
11707 E. Sprague Avenue, Suite 10E
Spokane Valley, WA 9920E
Permit Use:
yelne (Daytime Contact):
City
State
Zip Code
Phone #:
Mailing Addres // /07 `77
V City state Zip Code.
Contractor: et" License #:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL. AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or Tess than 100,000
X
$t2.00
=
2
FUEL BURNING APPLIANCE
More than 100,000
X
515.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
$50.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
5100.00
=
5
USED APPLIANCE (WSEC min. AFUE rating)
Equal to or less than 400,000
X
550.00
=
-
6
USED APPLIANCE (WSEC min. AFUE rating)
More than 400,000
X '
$100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
512.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
520.00
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
525.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$35.00
=
'
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
560.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
• 510.00
=
13
RANGE
• X
510.00
=
/ 0 `-r''
14
DRYER
X
510.00
=
15
FUEL BURNING WATER HEATER
X
510.00
=
16
MISC. FUEL BURNING APPLIANCE
X
510.00
=
17
GAS PIPING (each outlet)
X
$1.00
=
18
DUCT SYSTEMS
X
510.00
=
19
VENTILATING FANS
X
510.00
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or Tess than 10,000 CFM
X
512.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
515.00
=
22
EVAPORATIVE COOLERS_
X
510.00
=
23
TYPE I HOOD
X
550.00
=
24
TYPE II H000
X
510.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512.00
=
26
. AIR CONDITIONER '
3-15 TON
X
520.00
=
27
AIR CONDITIONER
15-30 TON
X
$25.00
=
28
AIR CONDITIONER
30-50 TON
X
535.00
=
29
AIR CONDITIONER
L. More than 50 TON
X
560.00
=
30
LPG STORAGE TANK
X
510.00
=
31
WOOD OR PELLET STOVE/INSERT
X
510.00
=
32
WOOD STOVE - FREE STANDING
X
525.00
=
33
REPAIR & ADDITIONS
X
515.00
=
34
VENTILATION SYSTEMS
X
• 512.00
=
35
VENTILATION MECHANICAL EXHAUST
X
512.00
=
36
INCINERATOR - RESIDENCE "
X
519.00
=
37
INCINERATOR - COMMERCIAL
X
$22.00
=
METHOD OF PAYMENT:
0 CASH ID CHECK 0 VISA 0 MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
535.00
EXPIRES:
TOTAL PERMIT FEE DUE:
C'
AUTHORIZED SIGNATURE: