2007, 05-04 Permit App: 07001602 Range, Piping ' ' Permit Center
11707 E Sprague Ave,Suite 106 PERMIT NUMBER: 7-1(00z,
Spokane Spokane Valley,WA 99206
valley" (509)688-0036 FAX:(509)688-0037 PERMIT FEE: ((,,,,
Community Development www.spokanevallev.or2 �V/
Mechanical Permit Application Z// Nl
/,❑ Commercial ',-Residential
SITE ADDRESS: / � A/ L-'*'' I S S
Building Owner bit. 15
Name: Phone: -2,0 S t'40 1 oq() Fax:
Address: /271 L %5 - City: 5 '/ State: A)4 ‘77v-2...._Zip:
Contractor ✓
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact �U(3
•r
Name: Phone:
DESCRIPTION OF WORK #OF UNITS 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 f X $10.00 =' / U
14 DRYER _ X $10.00 =
15 FUEL BURNING WATER HEATER X $10.00 =
16 MISC.FUEL BURNING APPLIANCE _ X $10.00 = est_
17 GAS PIPING(each outlet) f 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 IDCHECK -.5VISA ElMC EXPIRES: PROCESSING FEE $35.00
CARD#: VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: . C / _-
REVISED 8/26/05