2004, 01-14 Permit App: BLD-04-03407 Water Heater {{��crrr( lMuir,� 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
iJ ne Spokane Valley,WA 99206 509-688-0037-Fax
..."Valley
•Mechanical Permit Application ' 3 /O7
PROJECT • PERMIT
ADDRESS: j5-0 cfyAi USE:
OWNER: ', '/��'� ����/�1 � PHONE(Daytime Contact): 9z!L',, 6 38C,
MAILING ADDRESS:
(street) (city/state) (ZIP) 79 /
CONTRACTOR/ r / �_ ....pi �J LICENSE#: s ?g j f
/
MAILING ADDRESS: 1 PHONE#: CG
..7- 23 66406cir
,,4'770 2)1z c' 1?t2- ) F -8 J 41(
(street) (city/state) (ZIP)
DESCRIPTION OF WORK #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 501-1,000M 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 - •
13 RANGE - X $10 =
14 DRYER - X $10 = �
15 FUEL BURNING WATER HEATER - X $10 = /[/, Ou
16 MISC.FUEL BURNING APPL. - X $10 -
17 GAS PIPING(ea.Outlet) -- X $1 -
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - X $10 =
20 AIR HANDLER(DOES NOT include 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 CONDITIONER +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:
X6.. 0
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
TOTAL PERMIT FEE DUE: 75 d ��
If�7.SC:bY
is CASH 181CHECK ❑ liiiiiiii ❑ L___.-___.:.
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE: