2004, 10-04 Permit App: BLD-04-07829 Mechanical Fixtures o l•t 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
Spokane Spokane Valley,WA 99206 509-688-0037-Fax
4000Valley For Inspections, call 509-688-0054
'Mechanical Permit Application
PROJECT PERMIT
ADDRESS: O!7^ 514-L7
USE:
OWNER 7 jc C delN 7-Ak,At y PHONE(Daytime Contact): 92 Pi_ G -a
MAILING ADDRESS:
47440`l1. /. 514'4 76c5& . b) #41(JG.- 1144-1117 4.72/ 6
(street) (city/state) (Z
CONTRACTOR: LICENSE#: SMITHHC080R8
SMITH HEATING & COOLING, INC,
MAILING ADDRESS: PHONE#: 328-4431 FAX- 328-0749
E. 102 NORA SPOKANE WA 99207
(street) (city/state) (ZIP)
DESCRIPTION OF WORK 8 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 - .S X $10 - a a oC
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) - r X $1 - j OQ
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: a) O O
r
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
MIMI i- =```';'` TOTAL PERMIT FEE DUE 5 6 dQ
0 CASH in CHECK 0 1.1111MI ❑ -. ..__' -
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE: