2007, 10-05 Permit App: 07003992 Mechanical Fixtures �/� Permit Center
su«7'� a ..► 11703E Sprague Ave,Suite B-3
rials Spokane Valley,WA 99206 PERMIT NUMBER: c
.„„oj (509)688-0036 FAX:(509)688-0037 PERMIT FEE: 4
Community Development www.spokanevalley.oro r
Mechanical Permitt //Application �[1 Commercial ❑ Residential
SITE ADDRESS: !
j/ 4, •V v I lG`.Q ��.i'
Building Owner 46A,,,.._,
Name: •SC �i l"� r�"lG ,� Phone: _ 32 9 O Fax:
Address: City: State: Zip:
Contractor
Name: /-.---; j ` Phone: <+- Fax: / *�
Address: (.7s:/..:_,V. :7:-.(1---
,t` �� RQ,aL, K3 City: U State:��` Zip: (7 2 t 7
License No: �v°, T�'w // C5 RP City Busme Lie:
Contact /` '^ d
Name: t. //l, Oa Phone: c 3c - do . z.
DESCRIPTTION OF\ WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 1 X $12.00 = 42
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 UNLISTED APPLIANCE(Additional Fee) More than 400,000 X $100.00 =
5 USED APPLIANCE(WSEC 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 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $25.00 = -
10 BOILER/REFRIGERATION 1,001-1,750M BTU 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 $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 $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/INSERT X $10.00 =
32 WOOD STOVE-FREE STANDING X $25.00 =
33 REPAIR&ADDITIONS X $15.00 =
34 VENTILATION SYSTEMS X $12.00 =
35 VENTILATION MECHANICAL EXHAUST X $12.00 =
36 INCINERATOR-RESIDENCE X $19.00 =
37 INCINERATOR-COMMERCIAL X $22.00 =
METHOD OF PAYMENT: SUBTOTAL 13
❑CASH 0 CHECK 0 VISA 0 MC EXPIRES: PROCESSING FEE $35.00
CARD#: VIN: TOTAL PERMIT FEE DUE: i�G
6
AUTHORIZED SIGNATURE:
REVISED 8/26/05