2009, 02-20 Permit App: 09000414 Mechanical Fixtures Permit Center
S���Okane 11703 E Sprague Ave,Suite B-3
Spokane Valley,WA 99206 0-14PERMIT NUMBER: 1l -,
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'..Valley (509)688-0036 FAX:(509)688-0037 PERMIT FEE: SCD
Community Development permitcentern,spokanevalley.org
Mechanical Permit Application I I Commercial Residential
SITE ADDRESS: /Z%Ciel c 1) --S,- /:-.----7-
Building
Building Owner
Name: K, Ji 1,1 Phone: Fax:
Address: !Z em c. G )6.1.-S/1-7( 7 Ci k./1r/C� V p'9'ire, State: J.. tip.
Contractor 7
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Name: N/9-e--
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Phone: Fax:
Address: Zy ZD S 6/2,.,,0 gf,,,dp/ '13/e3 City:� S��Gc 4A/�� State:moi,7z ZIP.
_-24 Zi_Y
License No: City Business Lic:
Contact
Name: Phone:
DESCRIPTION OF WORK 1 #OF UNITS l X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 X $12.00 = ,
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 =
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 $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&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
❑CASH El CHECK VISA El MC EXPIRES. PROCESSING FEE $35.00
CARD#:
VIN' TOTAL PERMIT FEE DUE: _` •G/�/
AUTHORIZED SIGNATURE:
REVISED 8/26/05