2004, 01-14 Permit App: BLD-04-03406 Mechanicala'n c
� ane
, *Valley
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
Mechanical Permit Application
PROJECT
PERMIT
COST EQUALS
AMOUNT
ADDRESS: j S
= OR < 100,000
USE:
$15 -
OWNER:
PHONE (Daytime Contact):
Q O
MAILING ADDRESS:
3 UNLISTED APPLIANCE (ADDITIONAL FEE)
= OR <400,000
(street)
(city/state)
(Zip)
z J,,7—
CONTRACTOR:r
LICENSE #:
$100
MAILING ADDRESS:
PHONE #:
X
$50 =
6 USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
$100 =
7 BOILER/REFRIGERATION
1 -100M BTU
(street)
(city/state)
(Zip)
8 BOILER/REFRIGERATION
METHOD OF PAY
❑ CASH
DESCRIPTION OF WORK
#OF UNITS X
COST EQUALS
AMOUNT
1 FUEL BURNING APPLIANCE
= OR < 100,000
X
$15 -
2 FUEL BURNING APPLIANCE
> 100,000,
X
$19 =
3 UNLISTED APPLIANCE (ADDITIONAL FEE)
= OR <400,000
x
$50 =
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
$100 =
7 BOILER/REFRIGERATION
1 -100M BTU
X
$15 =
8 BOILER/REFRIGERATION
101 - SOOM 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
$10 =
14 DRYER
-
X
$10 -
15 FUEL BURNING WATER HEATER
-
X
$10
16 MISC FUEL BURNING APPL.
-
X
$10 -
17 GAS PIPING (ea. Outlet)
-
X
$1
18 DUCTSYSTEMS
_
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
$10 =
23 TYPE I HOOD
-
X
$50 -
24 TYPE 11 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
$25
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 =
RENT
n n I
SUBTOTAL:
PLUS PROCESSING FEE:
TOTAL PERMIT FEE DUE:
�6 01Gr
$35.00
06
CHECK
DATE: ' i /
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
u
EXPIRES: