2004, 08-06 Permit App: BLD-04-07281 Gas Log, Piping Scrrl•t 11707 Easi4Spragete Avenue,Suite 106 509-688-0036-Phone
pokane Spokane Valley,WA 99206 509-688-0037-Fax
do,Valley For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT PERMIT
ADDRESS: c;)0 e, S, (--j c(1,1,-)tiz-yj USE:
OWNER DI c t DI i 51'�- PHONE(Daytime Contact): of qc) ,25-0z.-)
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE 4:
SMITH HEATING & COOLING. INC. SMITHHC080R8
MAILING ADDRESS: PHONE4: 328-4431 FAX: 328-0749
E. 102 NORA SPOKANE WA 99207
(street) (city/state) (ZIP)
DESCRIPTION OF WORK a OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE -OR<100,000 X $15 -
2 FUEL BURNING APPLIANCE >100,000 X $19 -
3 UNLISTED APPLIANCE(ADDITIONAL FEE) -OR<400,000 X $50 -
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 -
5 USED APPLIANCE(WSEC min.AFUE rating) -or<400,000 X $50 -
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 -
7 BOILER/REFRIGERATION 1-100M BTU X $15 =
8 BOILER/REFRIGERATION 101-500M BTU X $28 -
9 BOILER/REFRIGERATION 501-L000M BTU X $39 -
10 BOILER/REFRIGERATION 1001-1,750M BTU X $57 -
11 BOILER/REFRIGERATION +1750M BTU X $95 -
12 GAS LOG,GAS INSERT,GAS FIREPLACE - X $10 - (v, 00
13 RANGE - X $10 -
14 DRYER - X $10 -
15 FUEL BURNING WATER HEATER - X $10 -
16 MISC FUEL BURNING APPL. - X $10 -
17 GAS PIPING(ea.Outlet) - I X $1 - f nO
18 DUCT SYSTEMS - X $10 -
19 VENTILATING FANS - X $10 -
20 AIR HANDLER(DOES NOT indude ducting) -OR<10,000CFM X $12 -
21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM X $19 -
22 EVAPORATIVE COOLERS - X $10 -
23 TYPE I HOOD - X $50 -
24 TYPE II HOOD - X $10 -
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 -
26 AIR CONDITIONER 3-15 TON X $20 -
27 AIR CONDITIONER 15-30 TON X $25 -
28 AIR CONDITIONER 30-50 TON X $35 -
29 AIR CONDMONER +50 TON X $60 -
30 LPG STORAGE TANK - X $10 -
31 WOOD OR PELLET STOVE/INSERT - X $10 -
32 WOOD STOVE-FREE STANDING - X $25 -
SUBTOTAL: I I. oO
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
TOTAL PERMIT FEE DUE:
0 CASH ] CHECK 0 0 L. ..2.:=i:':
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE: