2008, 02-25 Permit App: 08000573 Gas Piping Permit Center
w 11703 E Sprague Ave,Suite B-3 PERMIT NUMBER: ti--,7,:--)
SpOkane
Spokane Valley,WA 99206
400/S Vdlley" (509)688-0036 FAX:(509)688-0037
Community Development
www.svokanevalley.org PERMIT FEE:
Mechanical Permit Application CommercialQ gi ' esidential
SITE ADDRESS:J/5C� 7 3 //5-e L2--L- D /T
Building Owner
Name: y7 0,77.5 A!? Phone: Fax:
Address:48 ii.43 0 41 G L A A) City: .s State: Zip:
Contractor
Name: ALU `///�4.-7/4.-7/ 4:43 - //
/ 6 Phone: �� i/ Fax:
Address: ,/ ' �f0,_ City: 11 State: /} Zip:('G )3
License No: City Business Lie:
Contact p
Name: ,----)et A) C/9..01/08 -t c____ Phone: L/35- /l 7()
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 X $12.00 = Z /Z -CJ
2 FUEL BURNING APPLIANCE More than 100,000 X $15.00 =
3 UNLISTED APPLIANCE(Additional Fee) Equal to or less than 400,000 X $50.00 =
4 UNLISTED APPLIANCE(Additional Fee) More than 400,000 X $100.00 =
5 USED APPLIANCE(WSEC min.AFUE rating) Equal to or less than 400,000 X $50.00 =
6 USED APPLIANCE(WSEC min.AFUE rating) More than 400,000 X $100.00 =
7 BOILER/REFRIGERATION 1-100M BTU X $12.00 =
8 BOILER/REFRIGERATION 101-500M BTU X $20.00 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $25.00 =
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $35.00 =
11 BOILER/REFRIGERATION More than 1,750M BTU X $60.00 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE X $10.00 =
13 RANGE X $10.00 =
14 DRYER X $10.00 =
15 FUEL BURNING WATER HEATER X $10.00 =
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) X $1.00 ,= .,/. �� X Z-
18
18 DUCT SYSTEMS X $10.00 =
19 VENTILATING FANS X $10.00 -
20 AIR HANDLER(DOES NOT include ducting) Equal to or less than 10,000 CFM X $12.00 =
-
21 AIR HANDLER(DOES NOT include ducting) Greater than 10,000 CFM X $15.00 =
22 EVAPORATIVE COOLERS X $10.00 =
23 TYPE I HOOD X 1 $50.00 =
24 TYPE II HOOD X $10.00 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 =
26 AIR CONDITIONER 4-15 TON X $20.00 =
27 AIR CONDITIONER 15-30 TON X $25.00 =
28 AIR CONDITIONER 30-50 TON X $35.00 =
29 AIR CONDITIONER More than 50 TON X $60.00 =
30 LPG STORAGE TANK X $10.00 =
31 WOOD OR PELLET STOVE/INSERT X $10.00 =
32 WOOD STOVE-FREE STANDING X $25.00 =
33 REPAIR Sr ADDITIONS X $15.00 =
34 VENTILATION SYSTEMS X $12.00 =
35 VENTILATION MECHANICAL EXHAUST X $12.00 =
36 INCINERATOR-RESIDENCE X $19.00 =
37 INCINERATOR-COMMERCIAL X $22.00 =
METHOD OF PAYMENT: SUBTOTAL
OCASH 0 CHECK ISt4'❑MC EXPIRES: PROCESSING FEE $35.00 1
CARD#: I .:�_.3 ' TOTAL PERMIT FEE DUE: �. Uf
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AUTHORIZED SIGNATURE:
Effective 10-28-07 P.\Community Development\?mis\Building forms\Mechanical Permit Application dor