2003, 10-02 Permit App: BLD-03-02650 Furnace, Piping*lane
_#Valley
Mechanical Permit Application
11707 East Spraghe-Aveiiue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206
509-688-0037 - Fax
PROJECT
ADDRESS: i COG 4) FC- ' -
7k
PERMIT
USE:
OWNER: lJ, v /- 1 1,,K,-1
r� / , -1 u 1�
,1
PHONE (Daytime Contact):
Cj'q C _ o 3 c,
U
MAILING ADDRESS:
J
7,5- 0G Ai F IIS
sig0 kuAwe 1v,L -
cfg1 -0
6
(street)
(city/state)
(ZIP)
' 515
CONTRACTOR/1LICENSE
4v4 of r
- ' I
R:
FUEL BURNING APPLIANCE
> 100,000
MAILING ADDRESS: -•
X
PHONE t:
-
3
UNLISTED APPLIANCE (ADDMONAL FEE)
• OR<400,000
(street)
(dty/state)
(ZIP)
-
METHOD OF PA
0 CASH �C
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
5 OF !ARTS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
. • OR < 100,000
X
' 515
•
- ' I
2
FUEL BURNING APPLIANCE
> 100,000
X
519
-
3
UNLISTED APPLIANCE (ADDMONAL FEE)
• OR<400,000
X
550
-
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
>400,000
X
5100
.-
USED
USED APPLIANCE (WSEC mm AFUE rating)
or < 400,000
X
, 550
-
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
528
•
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
539
-
10
BOILER/REFRIGERATION
1001 - 1,750M BTU
X
557
-
11
BOILER/REFRIGERATION
•1750M 5713
X
595
12
GAS LOC, GAS INSERT, GAS FIREPLACE .
-
X
510
-
13
RANGE
-
X
510
•
14
DRYER
-
X
510
-
15
FUEL BURNING WATER HEATER
-
-
X
510
-
16
MEC FUEL BURNING APPL.
-
X
510
-
17
GAS PIPING (ea. Outlet)
-
X
51
•/1
18
DUCT SYSTEMS
-
X
$10
-
-f
19
VENTILATING FANS
-
X
510
-
20
AIR HANDLER (DOES NOT indude ducting)
• OR<10,000CFM
X
112
-
21
AIR HANDLER (DOES NOT mdude ducting)
> 10,000 CFM
X
519
-
22
EVAPORATIVE COOLERS
-
- -
X
510
-
23
TYPE I HOOD
-
X
550
-
24
TYPE II HOOD
-
X
510
-
25
HEAT PUMP/AIR COND['IIONER
0-3 TON
X
512
-
26
AIRCONDMONER
3-15 TON
-
X
520
-
27
AIR CONDRIONER
15-30 TON
X
525
-
28
AIRCONDMON£R
30-50 TON
X
535
-
29
AIR CONDITIONER
.50 TON
X
560
-
30
LPG STORAGE TANK
-
X
510
•
31
WOOD OR PELLET STOVE/INSERT
-
X
' 510
-
32
WOOD STOVE -FREESTANDING
_
X
525
-
HENT
Mat
VISA'
rt: nv n
y ; . ,:
-.
SUBTOTAL:
1%,00
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE: t ) O b
) J 11
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: