2003, 09-23 Permit App: BLD-03-02558 Gas Log, Piping*lane'�
®'Walley
Mechanical Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206
509-688-0037 - Fax
PROJECT _I
ADDRESS: 1 $! 1 5 Fells ry
PERMIT
USE:
OWNER rad
7`C•I LQ) 5 0 y
1 J
2 OF UNITS
PHONE (Daytime Contact): Oo� Ci
9a(o—
MAILING ADDRESS:
EQUALS
AMOUNT
1
(street)
• OR < 100,000
(city/state)
(ZIP)
CONTRACTOR: Ti- U Q
V / In.t
a i-frM5
LICENSE tt:
FUEL BURNING APPLIANCE
MAILING ADDRESS: • •
JPHONE
2:
9a-i-gg7gg
3
(street)
• OR <400,000
(city/state)
(ZIP)
METHOD OF PA
0 CASH 0 C
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
2 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
5100
•
5
USED APPLIANCE (WSEC min. 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
522
•
9
BOILER/REFRIGERATION
501- 1,000M BTU
X
539
•
10
BOILER/REFRIGERATION
1001- 1,750M BTU
X
557
•
11
BOILER/REFRIGERATION
+1750M BTU
X
595
•
12
GAS LOC, GAS INSERT, GAS FIREPLACE
-
X
510
•
' Cr
13
RANGE
-
X
510
•
14
DRYER
-
X
510
-
15
FUEL BURNING WATER HEATER
-
X
510
•
16
MOSC FUEL BURNING APPL
-
X
510
•
17
GAS PIPING (ea Outlet)
-
X
51
-
'
18
DUCT SYSTEMS
-
X
510
•
19
VENTILATING FANS
-
X
510
•
20
AIR HANDLER (DOES NOT includeducdng)
• OR < 10,000CEM
X
512
•
21
AIR HANDLER (DOES NOT include 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/AIRCONDITIONER
0-3 TON
X
512
•
26
AIR CONDITIONER
3-15 TON
X
520
•
27
AIRCONDDIONER
15.30 TON
X
575
-
22
AIRCONDITIONER
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
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
46.00
:..
vl5n' _ t �
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE: