2004, 08-06 Permit App: BLD-04-07286 AC TO'3Jdd SOS Tt78b60S Et':ST t700Z 9Z l(lf
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City of
Spokane Valley Mechanical Permit Application Fax#888-0037
Project Permit
Address: 1908 N Salmon River Use:
Owner: Allen Kudronowicz Phone(daytime contact):
869-9639
Mailing Address SAME
(street) (city/state) (zip)
Contractor: R&R Heating and AC, Inc. License: RRHEAA1088W
Mailing Address 4019 E Central Phone#: 484-1405
Spokane,Wa 99217
(street) (dty/state) (zip)
Description of Work #of units Cost = Amount
1 Fuel burning appliance -or<100,000 X 15.00 = 0.00
2 Fuel burning eppllance >100.000 X , 19.00 = 0.00
3 Unlisted appliance(additional charge) -or<400,000 X 50.00 a 0.00
4 Unlisted appliance(additional charge) >400,000 X 100.00 = 0.00
5 Used appliance(WSECs min.AFUE rating) -or<100,000 X 580.00 = 0.00
6 Used appliance(WSECs min.AFUE rating) >400.000 X 100.00 = 0.00
7 Boiler/refrigeration 1-100M BTU , , X , 15.00 = 0.00
8 Boiler/refrigeration 101-500M BTU , X 28.00 = r 0.00
9 Boiler/refrigeration 501-1,000M BTU X 39.00 = ,. 0.00
10 Boiler/refrigeration ,1,001-1,750M BTU, X 57.00 = 0.00
11 Boiler/refrigeration +1.750M BTU X 95.00 = 0.00
12 Gas log,gas insert.gas fireplace - X 10.00 = 0.00
_ 13 Range - , X 10.00 = 0.00
14 Dryer - _ X 10.00 = 0.00
15 Fuel burning water heater - X 10.00 = 0,00
16 Miscellaneous fuel burning appliance - X 10.00 = 0.00
17 Gas pipIng,(each outlet) - , X 1.00 = 0.00
18 Duct systems - , X 10.00 = 0.00
19 Ventilating fans - X 10.00 = 0.00
. 20 Air handler(does not include ducting) -or<10,000 CFM X 12.00. = 0.00
21 Air handler(does not Include ducting) >10,000 CFM X 19.00 0.00
22 Evaporative coolers - X 10.00 = 0.00
23 Type I hood - X 50.00 = 0.00
24 Type U hood - X 10.00 = 0.00
25 Heat pump/air conditioner
0-3 tons 1 X 12.00 s 12.00
28 Air conditioner 3-15 tons X 20.00 0.00
27 Air conditioner 15-30 tons X 25,00 = 0.00
28 Air conditioner 30-50 tons X , 35.00 = 0.00
29 Air conditioner +50 tons X 60.00 = 0.00
30 LPG storage tank - X 10.00 = 0.00
31 Wood or pellet stove/insert - X 10.00 = 0.00
32 Wood stove-free standing - X . 25.00. = A 0.00
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❑ Cash 0 Check 0 Visa 0 MasterCard Subtotal12.00
Faxed permits wit only be accepted with payment of a major credit card Plus Processing
Fee 35.00
Date: Expires: Total Permit Fee
Due 47.00
Bankcard Number.
Authorized Signature: I- i :xi-
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