2005, 10-27 Permit App: 05004067 Insert Permit Center
*Wane`" ` 11707E Sprague Ave,Suite 106
l . .t PERMIT NUMBER:
0. ey Spokane Valley,WA 99206
40(..07-3-,
(509)688-0036 FAX:(509)688-0037 PERMIT FEE: (
Community Development www.spokanevalley.ore.com a -
Mechanical Permit Application - ❑ Commercial ki Residential
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SITE ADDRESS: S , �`�rV � '
Building owner
Name: Sf G3,(.)Y-1 4) .4ft(� c)eA Phone: c( c l p(�" Fax:
Address: Ulm Cj. NK14 0.--j.)\ R , City: i_ t 9.L V(*-. State: LA-10r Zip:C/610 )
Contractor
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business License No:
Contact �
Name: ��'kA"'' 'e_-- s Phone: c4vZ 63: C __
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 I X $10.00 = /0.CG
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 ,=
17 GAS PIPING(each outlet) 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 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 =
_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 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE: 1603
AUTHORIZED SIGNATURE: REVISED 8/26/05