2004, 08-20 Permit App: BLD-04-07414 PipingSPlane
,,.Dalley
MECHANICAL PERMIT APPLICATION
City of Spokane Valley Corrimunity Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: / YSz2 %•- 01 ,- 5S its Permit Use:
Owner 5 Vee, S�cwoi yl-a-,-vq Phone (Daytime Contact):
Mailing Address: / Scc.-wr(_.
City State Zip Code
Contractor: ��� 'a j/YI P ; ca I License #: r• 3 3 L Phone #: 9077- Z S 2l/
Mailing Address: �Jo ))( /9 ICY. J i - - 99 y /
/ City State Zip code
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100 000
X
315.00
=
2
FUEL BURNING APPLIANCE
More than 100,000
X
319.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
350.00
- =
4
UNLISTED APPLIANCE (Additional Fee)
More than 400 000
X
3100.00
=
5
USED APPLIANCE (WSEC min. AFUE
rating)
Equal to or less than 400,000
X
350.00
=
6
USED APPLIANCE (WSEC min. AFUE
rating)
More than 400,000
X
$100.00
=
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
539.00
=
10
BOILER/REFRIGERATION
1,001 -1 750M BTU
X
557.00
=
11
BOILER/REFRIGERATION
More than 1 750M BTU
X
595.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10.00
=
13
RANGE
X
310.00
=
14
DRYER
X
510.00
=
15
FUEL BURNING WATER HEATER
X
510.00
=
18
MISC. FUEL BURNING APPLIANCE
X
310.00
=
17
GAS PIPING (each outlet)
/
X
$1.00
=
/ _ O U
18
DUCT SYSTEMS
X
310.00
=
19
VENTILATING FANS
X
510.00
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
X
312.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
519.00
=
22
EVAPORATIVE COOLERS
X
310.00
=
23
TYPE I HOOD
-
X
350.00
=
24
TYPE II HOOD
X
310.00
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
312.00
=
28
AIR CONDITIONER
3-15 TON
X
520.00
=
27
AIR CONDITIONER
15-30 TON
X
325.00
=
28
AIR CONDITIONER
30-50 TON
X
535.00
=
29
AIR CONDITIONER -
More than 50 TON
X
580.00
=
30
LPG STORAGE TANK
X
310.00
=
31
WOOD OR PELLET STOVE/INSERT
X
310.00
=
32
WOOD STOVE - FREE STANDING
_
X
525.00
=
METHOD OF PAYMENT:
•
❑ CASH 0 CHECK 0 VISA OMC
CARD #:
DATE:
SUBTOTAL
/ • O 0
PROCESSING FEE
335.00
EXPIRES.
TOTAL PERMIT FEE DUE:
34 . Lt"O
^
AUTHORIZED SIGNATURE: