2004, 07-16 Permit App: BLD-04-07090 Gas Log, PipingS*�kSw4
Project Address:
Owner:
Mailing Address:
MECHANICAL PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
IC(41(2
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact):
City
Contractor:
License #: Phone #:
Mai ing Address:
State
State
Zip Code
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
FUEL BURNING APPLIANCE
Equal to or less than 100,000
X
$15.00
=
1
FUEL BURNING APPLIANCE
More than 100,000
X
$19.00
=
2
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
$50.00
=
3
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
$100.00
=
4
5
USED APPLIANCE (WSEC min. AFUE
Equal to or less than 400,000
X
$50.00
=
rating)
USED APPLIANCE (WSEC min. AFUE
More than 400,000
X
$100.00
=
6
rating)
7
BOILER/REFRIGERATION
1 - 100M BTU
X
$15.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$28.00
=
9
BOILER/REFRIGERATION
501 -1,000M BTU
X
$39.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$57.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
$95.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
1
X
$10.00
=
1 O.c
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
=
G
17
GAS PIPING (each outlet)
/
X
$1.00
=
1 - a
18
DUCT SYSTEMS
X
$10.00
=
19
VENTILATING FANS
X
$10.00
=
20
AIR HANDLER (DOES NOT indude 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
$19.00
=
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
3-15 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
=
METHOD OF PAYMENT:
DATE:
SUBTOTAL
PROCESSING FEE
$35.00
0 CASH 0 CHECK 0 VISA 0 MC
�_ --TOTAL
EXPIRES:
PERMIT FEE DUE:
1j`�
7 k O/
AUTHORIZED SIGNATURE:
Zip Code