2003, 05-01 Permit: BD03-064 Gas Piping Credit*ohne
®Walley
Mechanical Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206
509-688-0037 - Fax
bo c -oc0 cj
PROJECT
ADDRESS: 4...1 fl 29 6' r&ec- Av-c,
PERMIT
USE:
OWNER E UoA2�� l�A ei1��
1 `�
PHONE (Daytime Contact):
9 L$_ s-cj 2_,/MAILING
ADDRESS:
E, ( ( 9 24( 6, recce__
Avc. S pc, ca -.NL W D,•
9112-00
(street)
(city/state) (ZIP)
1
CONTRACTOR:
515
LICENSE #:
I5 -al
MAILING ADDRESS:
FUEL BURNING APPLIANCE
PHONE #:
X
519
(street)
(city/state) (ZIP)
3
METHOD OF PA
❑ CASH ❑ C
DATE: - EXPIRES.
BANKCARD NUMBER.
AUTHORIZED SIGNATURE:
Bon -
r
DESCRIPTION OF WORK
4 OF UNITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
• OR < 100,000
1
X
515
-
I5 -al
2
FUEL BURNING APPLIANCE
> 100,000
X
519
-
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 c 400,000
X
$50
6
USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
5100
-
7
BOILER/REFR10ERATION
1 - 10UM 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
$57
11
BOILER/REFRIGERATION
•1750M 811/
X
595
-
12
GAS LOC, GAS INSERT, GAS FIREPLACE
-
X
510
-
13
RANCE
-
X
510
=
14
DRYER
-
X
510
-
15
FUEL BURNING WATER HEATER
-
X
510
16
MISC FUEL BURNING APDL
-
X
510
-
17
GAS PIPING (ea Outlet)
-
x
51
-
(
18
DUCE SYSTEMS
-
X
510
-
19
VENTILATING FANS
-
X
510
20
AIR HANDLER (DOES NOT mdude ducting)
• OR < 10,0WCFM
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/AIRCONDITLONER
0-3 TON
X
512
-
26
AIR CONDITIONER
3-15 TON
X
520
27
AIR CONDITIONER
15-30 TON
X
525
23
AIR CONDITIONER
30-50 TON
X
535
-
29
AIR CONDITIONER
+50 TON
X
$60
•
30
LPG STORAGE TANK
-
X
510
-
31
WOOD OR PELLET STOVE/INSERT
-
X
510
-
32
WOOD STOVE - FREE STANDING
-
X
525
-
HENT
Min -' '�
.
-
SUBTOTAL:
f(-0-6°
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE 7— I\%( -VISA
DATE: - EXPIRES.
BANKCARD NUMBER.
AUTHORIZED SIGNATURE:
Bon -
r