2003, 12-03 Permit App: BLD-03-03190 Insert, PipingWhile
a,, #Valley
Mechanical Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
509-688-0037 - Fax
Spokane Valley, WA 99206
PROJECT
ADDRESS: 'J O 7 .. �-• / eie,
PERMIT
USE:
OWNER:`/G �17 70-
PHONE (Daytime e Contact):
COST
e�turA--L
...5e—e,
MAILING ADDRESS:
�07�, _ � al- tcyQ t Glia-
f9;/4
(street) (city/state) /
IP)
. • OR <100,000
CONTRACTOR: I
LICENSE #:
' 515
,���
(��-L/
MAILING A SS: • •
�/�PPHONE
/G/0777 �% //e '2V
!I: I 0 c v' 7
> 100,000
h% Qi'
-/
c
(street) (city/state) (ZIP)
METHOD OF PA
❑ CASH 0
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
P OF UNITS
X
COST
EQUALS
AMOUNT
I
FUEL BURNING APPLIANCE
. • OR <100,000
X
' 515
-
2
FUEL BURNING APPLIANCE
> 100,000
X
$19
-
3
UNLISTED APPLIANCE (ADDMONAL 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
‘ 550
•
6
USED APPLIANCE (WSEC min. AFUE rating)
>400,000
X
5100
•
7
BOILER/REFRIGERATION
1-100M BTU
X
515
-
8
BOILER/REFRIGERATION
101- 500M BTU
X
523
-
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
$39
-
10
BOILER/REFRIGERATION
1001- 1,750M BTU
X
557
•
11
BOILER/REFRIGERATION
+175014 BTU
X
$95
-
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
X
510
-
AD
13
RANGE
-
X
510
-
14
DRYER
-
X
510
•
15
FUEL BURNING WATER HEATER
-
-
X
510
-
16
M15C FUEL BURNING APPL.
-
X
510
•
17
GAS PIPING (et Outlet)
-
X
51
•
/
18
DUCT SYSTEMS
-
X
510
•
19
VENTILATING FANS
-
X
510
-
20
AIR HANDLER (DOES NOT Include ducting)
• OR c 10,003CFM
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 IIHOOD
-
X
510
-
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512
-
26
AIRCONDITIONER
3.15 TON
X
520
•
27
AIR CONDMONER
15.30 TON
X
525
•
28
AIRCONDITIONER
30-50 TON
X
535
•
29
AIRCONDMONER
+50 TON
X
S60
-
30
LPG STORAGE TANK
-
X
510
•
31
WOOD OR PELLET STOVE/INSERT
-
X
' 510
-
32
WOOD STOVE -FREESTANDING
-
X
525
-
.LENT
yam' —.a ; t.;g
SUBTOTAL:
//
PLUS PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE /-/e#aG
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: