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2004, 02-18 Permit App: BLD-04-03579 Gas Piping*lane ,�,.•� Valley Mechanical Permit Application 11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone Spokane Valley, WA 99206 509-688-0037 - Fax For Inspections, call 509-688-0054 PROJECT ADDRESS: .5 0 0 4 DESCRIPTION OF WORK A) L. \, ' J C.:1 -USE: X COST PERMIT 6S, ?iQ e_ OWNER: ems} FUEL BURNING APPLIANCE 's • -t 5 X $15 PHONE (Daytime Contact): 110_ t & S.2_ MAILING ADDRESS: J 0 o `l 2 N i—'. \\ ; c..,J <LL- `'I', (C,.,,.>< L—)A `11'24 L (street) 3 UNLISTED APPLIANCE (ADDITIONAL FEE) = OR <400,000 (city/state) $80 - (ZIP) CONTRACTOR: 4.LICENSE > 400,000 X $100 = #: USED APPLIANCE (WSEC min. AFUE rating) MAILING ADDRESS: X $50 = 6 USED APPLIANCE (WSEC min. AFUE rating) PHONE #: X $100 = 7 (street) 1-100M BTU X $15 (city/state) 8 (ZIP) METHOD OF PA ❑ CASH ❑ C DATE: EXPIRES: BANKCARD NUMBER.: AUTHORIZED SIGNATURE: DESCRIPTION OF WORK # OF UNITS X COST EQUALS AMOUNT 1 FUEL BURNING APPLIANCE = OR < 100,000 X $15 = 2 FUEL BURNING APPLIANCE > 100,000 X $19 - 3 UNLISTED APPLIANCE (ADDITIONAL FEE) = OR <400,000 X $80 - 4 UNLISTED APPLIANCE (ADDITIONAL FEE) > 400,000 X $100 = 5 USED APPLIANCE (WSEC min. AFUE rating) = or < 400,000 X $50 = 6 USED APPLIANCE (WSEC min. AFUE rating) > 400,000 X $100 = 7 BOILER/REFRIGERATION 1-100M BTU X $15 = 8 BOILER/REFRIGERATION 101- 500M BTU X $28 = 9 BOILER/REFRIGERATION 501-1,000M BTU X $39 = 10 BOILER/REFRIGERATION 1001-1,750M BTU X $57 = 11 BOILER/REFRIGERATION +1750M BTU X $95 = 12 GAS LOG, GAS INSERT, GAS FIREPLACE - X $10 - 13 RANGE -- X $10 - 14 DRYER - X $10 - 15 FUEL BURNING WATER HEATER -- X $10 = 16 MISC. FUEL BURNING APPL. - X $10 = 17 GAS PIPING (ea. Outlet) - X $1 = 18 DUCT SYSTEMS - X $10 - 19 VENTILATING FANS - X $10 20 AIR HANDLER (DOES NOT include ducting) = OR < 10,000CFM X $12 = 21 AIR HANDLER (DOES NOT include ducting) > 10,000 CFM X $19 = 22 EVAPORATIVE COOLERS - X $10 = 23 TYPE I HOOD - X $50 = 24 TYPE II HOOD -- X $10 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 = 26 AIR CONDITIONER 3-15 TON X $20 - 27 AIR CONDITIONER 15-30 TON X $25 - 28 AIR CONDITIONER 30-50 TON X $35 = 29 AIR CONDITIONER +50 TON X $60 = 30 LPG STORAGE TANK - X $10 = 31 WOOD OR PELLET STOVE/INSERT - X $10 = 32 WOOD STOVE - FREE STANDING - X $25 = KENT yj$q' r'Sc SUBTOTAL: PLUS PROCESSING FEE: 43,5,98------.. TOTAL PERMIT FEE DUE: DATE: EXPIRES: BANKCARD NUMBER.: AUTHORIZED SIGNATURE: