2004, 09-17 Permit App: BLD-04-07683 Water Heater orY Otri 01111."\111014041* 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
3poiie Spokane Valley,WA 99206 509-688-0037-Fax
.0001/alley
•Mechanical Permit Application
PROJECT PERMIT
ADDRESS: 30 6 5 .c USE:
OWNER: /� PHONE(Daytime Contact):
C ^7i lam !
MAILING ADDRESS: G
.azo- --/
(street) (city/state) (ZIP)
CONTRACTOR/ r ve n _ vi r C a l LICENSE#: 5c_s 9 `( /
MAILING ADDRESS: ` c PHONE#: GCg
3) 66 06q/2
,4'720 e.b/F- D )•R I 47(
(street) (city/state) (ZIP)
DESCRIPTION OF WORK It OF UNTTS 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 = /4
16 MISC FUEL BURNING APPL. - X $10 =
17 GAS PIPING(ea.Outlet) - X $1 •
•
18 DUCF 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: ) e--
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
pj TOTAL PERMIT FEE DUE:
❑ CASH El CHECK ❑ ❑ L__ .....:__....i'
DATE: 9-1E 7-`1,7 EXPIRES:
BANKCARD NUMBER.:
AUTI-IORIZED SIGNATURE: