2004, 10-26 Permit App: BLD-04-08039 Mechanical FixturesSilolane
n
4,000Valley
Project Address: ___/3
..OWner.. C 7,-l)
''Mailing A (dress:
Contractor:
Mailing Address:
DESCRIPTION OF WORK
FUEL BURNING APPLIANCE
10
UNUSTEDAPPLIANCE Additional Fee
UNLISTED APPLIANCE Additional Fee
USED APPLIANCE (TA/SEC min. AFUE
rat
USED APPLIANCE (WSEC min. AFIJE
ra
BOILER/REFRIGERATION
BOLLER/REFRIGERAT1ON
BOILER/REFRIGERATION
BOILER/REFRIGERATION
BOILF_R/REFRIGERATION
GAS LOG GAS INSERT GAS FIREPLACE
RANGE
DRYER
FUEL BURNING WATER HEATER
MISC. FUEL BURNING APPLIANCE
romewirminm
20
22
DUCT SYSTEMS
VENTILATING FANS
AIR HANDLER ' OES NOT Include ductin
AIR HANDLER ES NOT includeductn
EVAPORATIVE COOLERS
TYPE HOOD
TYPE II HOOD
HEAT PUMP/AIR CONDITIONER
AIR CONDfTIONER
R D ITIUNEt
AIR CONDITIONER
AIR CONDITIONER
LPG STORAGE TANK
WOOD OR PELLET STOVEIINSERT
WOOD STOVE - FREE STANDING
METHOD OF PAYMENT:
❑ CASH ❑ CHECK *VISA Q MC
CARD #:
AUTHORIZED SIGNATURE:
Ja-
CityState
License #: CCZ C / Phone #:
MECHANICAL PERMIT APPLICATION
City of Spokane Valley Corn`rnunity Development Department
Buildingoivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, .CALL, (509) 688-0054
Permit Use:
Phone (Daytime Contact):( --At›.
E. ual to or less than 100 000
•
e
ars_ ,re r
E • I to or less than 400 000
' More than 400 000
uat to or less than 4
More than 400 000
• 1-100MBTU •
101 - 500M BTU
501 -1,000M BTU
1 001 -1750M BTU
More than 1 750M BTU
000
E • ual to or less than 10 000 CFM
Greater than 10 000 CFM
• 0-3 TON
3-15 TON
DATE:
13-30 TO
30,50 TON
More than 50 TON
EXPIRES:
•
Zip Code
. I# OF
UNITS X
COST
-
v TOTAL
AMOUNT
X
$15.00
=�
Kg
x
x
X
II$100.00
111
X
X
X
X
. X
III
X
$15.00
$50.00
$too.00
$50.00
15.00•
$28.00
$39.00
$57.00
$95.00
$10.00
$10.00
$10.00
II 11 MIS II H H. 0' Y n U: (i
4
X
$10.00
X
$t0.o0
= .
x
$1.00
X
$10.00
=
X
$10.00
X
$12.00
X
$19.00
'
X
$10.00
='
X
$50.00
=
X
$10.00
=
X
$12.00
= '
X
$20.00
= -,
N$25.00
=
$35.00
x
$60.00
=
X
$10.00
X
$10.00
X
$25.00
=
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE: / 1/ a -o
Zip Code
•