2004, 06-01 Permit App: BLD-04-04471 AC sEN,00%.,
ponne
. - MECHANICAL PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
le`j 11707 E. Sprague Avenue, Suite 106
40,Val
Spokane Valley, WA 99206
�] Phone: (509)688-0036;Fax: (509) 688-0037
l/�� FOR INSPECTIONS, CALL(509)688-0054
Project Address: r / / Z �7ti4 �- P Permit Use:
Owner: 4411 f/t-4-ail Phone(Daytime/Contact):
Mailing Address: /Z5/ 7 c.---"'" ,SA 4-�P S/0/ r LA"e-._., Zi 4
City 7 State..-3Zi Code
Contractor:- /�.�-,,t Cs--,L.,'T S"ids '&., license#: SSi6/cr 58'// Phone#: 3 2V- 7 Y
Mailing Address: 2 v`7 S S. z4 5,7170 ti.. 6A-. EA' 0,-.1 ) 4.4- 25-,3'.(0.,
City State Zip Code
#OF ' TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 X $15.00 =
2 FUEL BURNING APPLIANCE More than 100,000 X $19.00 =
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 =
USED APPLIANCE(WSEC min.AFUE
5 rating) Equal to or less than 400,000 X $50.00 =
USED APPLIANCE(WSEC min.AFUE
6 rating) More than 400,000 X , $100.00 =
7 , BOILER/REFRIGERATION 1-100M BTU X $15.00 =
8 BOILER/REFRIGERATION 101-500M BTU X $28.00 =,
9 ` BOILER/REFRIGERATION 501-1,000M BTU X $39.00 =
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $57.00 =
11 BOILERIREFRIGERATION More than 1,750M BTU X $95.00 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE X $10.00 =
$10.00
13 RANGE X -
14 DRYER X $10.00 =
15 FUEL BURNING WATER HEATER X $10.00 =
16 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 $19.00 =
22 EVAPORATIVE COOLERS X $10.00 =
23 TYPE I HOOD X $50.00 =
24 TYPE It HOOD X $10.00 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON I X $12.00 = //
L • cs U
26 AIR CONDmONER 3-15 TON X $20.00 =
27 AIR CONDITIONER 15-30 TON X $25.00 =
28 AIR CONDITIONER30'-50 TON X-i $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 X1 $10.00 =
32 WOOD STOVE-FREE STANDING X $25.00 =
METHOD OF PAYMENT: SUBTOTAL /I '0...4
DATE:
0 CASH CHECK ❑VISA ❑MC PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE: 7 6'U
AUTHORIZED SIGNATURE: �. ( --s