2004, 07-07 Permit App: BLD-04-07028 Heat Pump, AC . MECHANICAL PERMIT APPLICATION
Spiel City of Spokane Valley Community Development Department
BuildingDivision
lie 11707 E. Sprague Avenue, Suite 106
40110,Vay Spokane Valley, WA 99206Phone:
(509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS,,n/ CALL(5T 688-0054
S . U Yi 'e 3) Permit Use: Y Y tX
Project A.•ress: 5 �� c -
Owner: Q G It ! lat _ Phone (Daytime Contact): 02
, Mailing Address: SLIP Irl 1 L) 2 Si f-il • I,
• Contractor: 1(v 1 Y1i y. License#: 1r t i _ . 0 41 Phone*. 3 ' _ `�f
Mailing Address: `�03/) t Irl' S5 OD 40 r.,4 `") ) --6c
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 X $� =
5 rating) Equal to or less than 400,000
USED APPLIANCE(WSEC min.AFUE X $100.00 =
6 rating) More than 400,000
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 BOILER/REFRIGERATION More than 1,750M BTU -X $95.00 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE , X $10.00 =
13 RANGE X $10.00 =
X $10.00 =
14 DRYER '
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 II HOOD X $10.00 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 = 1 a bo
26 AIR CONDITIONER 3-15 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 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE Q 1 fZ,--,