2009, 03-03 Permit App: 09000487 Mechanical Fixture i Permit Center
11703 E Sprague Ave,Suite B-3 PERNIIT NUMBER
► ll� Spokane Valley,WA 99206 � �,
� �` (509)688-0036 FAX:(509)688-0037 PERMIT FEE: .:-Z)
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Community Development ww�v.spoicanevalievssra
Mechanical Permit Application ❑Commercial ®Residential
SITE ADDRESS: t 3 q ()(., F . S¢-,c-i,Y'
Building Owner
Name: Sil -cavi -19•10 vleN C, Phone: 2-
S �18- 0 Z`1 at Fax:
Address: (3qv(0 S1n0-r , City: .�-.ra! ovi,k. State: 1,v A. Zip: g6721b
Contractor
Name; Phone: q2G-�00O Fax
55Z- 800
EFF(CI ENCY PLUS City: S o State: W Zip: gg2.16
Address: 1 4 2 /1 E $1-00.4)w K e'-1,
License No: E F FIC. 1-1 ciQ 13-? City Business Lie:
Contact
IName: ,j-t_pc Phone: q 2 G-40 G O
DESCRIPTION OF%WAX #OF UNITS X COST = TOTAL AMOUNT
1 `FUEL BURNING APPLIANCE
Equal to or less than 100,000 / X $t3.00 ,= /3. CAD
2 FUEL BURNING APPLIANCE More than 100,000 X $15.00 =
3 UNLISTED APPLIANCE(Additional Fee) Equal to or less than 400,000 , X $50.00
4 UNLIs i tU APPLIANCE(Additional Fee) More than 400,000 , X $100.00 =
5 USED APPLIANCEJWSEC min.AFUE rating) Equal to or less than 400,000 X $50.00 = ,
6 USED APPLIANCE(WSEC min.AFUE rating) More than 400,000 X , $100.00 = .
7 BOILER/REFRIGERATION 1-100M BTU X $12.00 =
8 BOILER/REFRIGERATION 101-500M BTU X , $20.00 i = ,
9 BOILER/REFRIGERATION 501-1,000M BTU X $25.00 =
10 BOILER/REFRIGERATION 1,001-1,750MBTU X $35.00 =
11 BOILER/REFRIGERATION More than 1,750M BTU _ X $60.00 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE X $10.00 _ =
13 RANGE X $10.00 =
14 DRYER X $1000 =-
15 FUEL BURNING WATER HEATER X $10.00
18 MISC.FUEL BURNING APPLIANCE X $10.00
17 GAS PIPING(each outlet) _ . X $1.00 _ =
18 DUCT SYSTEMS _ X $10.00 �=
19 VENTILATING FANSX , $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 $15.00 =
22 EVAPORATIVE COOLERS X $10.00 =
23 _TYPE I HOOD X $50.00 =
24 TYPE II HOOD X $10.00 , _ ,
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 =
26 AIR CONDITIONER 4-15 TON X $20.00 =
27 AIR CONDITIONER 15-30 TON X $25.00 =
28 AIR CONDITIONER 30-50 TON X $35.00 =
29 _AIR CONDITIONER More than 50 TON , X $60.00 •_
30 LPG STORAGE TANK , X $10.00 _ =
31 WOOD OR PELLET STOVE/INSERTX $10.00 =
32 WOOD STOVE-FREE STANDING X $25.00 =
33 REPAIRS ADDITIONSX $15.00
34 VENTILATION SYSTEMS X $12.00 =
35 VENTILATION MECHANICAL EXHAUSTX $12.00
36 INCINERATOR-RESIDENCE X $19.00 =
1 37 INCINERATOR-COMMERCIAL
X $22.00 =
METHOD OF PAYMENT: SUBTOTAL
MASH 0 CHECK D VISA El MC EXPIRES: PROCESSING FEE S$"0
VIN:
CARD#: TOTAL PERMIT FEE DUE: J o •0Q
AUTHORIZED SIGNATURE:
REVISED 8/26/05