2007, 08-23 Permit App: 07003322 Gas Insert, Piping ,/� Permit Center
•}Q n�/e! 11703E Sprague Ave,Suite B-3 PERMIT NUMBER: 33 Cry
Spokane Valley,WA 99206
fValley` (509)688-0036 FAX:(509)688-0037 PERMIT FEE: 1\Ly
Community Development
www.spokanevalley.org ,----
Mechanical
Mechanical Permit Application 111
❑ Commercial Residential ( �J
SITE ADDRESS: /�-) �' (% f'-7----,L)-1,,s_.(__. ..1� IR F--.i, C.L_/ ip (A." .} l,/a.A... ( ..�' , 1,( p �i'-l��
Building Owner (!f
Namc: Phone: - ? L
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Address:t t 75' ,, f,-r ,,,�(_ -k)L City: Z State: Zip: (./ ti
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Contractor
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact ,
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 =
2.)GAS LOG,GAS INSERT,GAS FIREPLACE / X $10.00 = ( Ll . V 0
3 RANGE X $10.00 =
14 DRYER X $10.00 =
15FUEL BURNING WATER HEATER X $10.00 =
6 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 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 0 CHECK 0 VISA 0 MC EXPIRES: PROCESSING FEE $35.00
CARD#: /lN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: --0--\1-1-(-1 ,.. ,,t/ L
REVISED 8/26/05 l