2010, 12-27 Permit App: 10004134 Mechanical Fixtures Permit Center (1 4 I,Lt
�i�' 11707E Sprague Ave,Suite 106
S okane PERMIT NUMBER:
p Spokane Valley,WA 99206 LCLA
mispiii0 VA,lley` (509)688-0036 FAX:(509)688-0037
a www.spokanevalleV.ore PERMIT FEE:
Community Development
Mechanical Perm/.2,16"
t Application` / ❑ Commercial ❑ Residential
SITE ADDRESS: 1.�,1 5- V i l of,f\
Building Owner S
Name: S--r(1UG , A)-72,0 t(J v)eP4- Phone: Cg-t,/q..2&-_ 6 t/ Fax:
Address: J / Z 2 c� �j, V1 (ems i uL'vn City: C 03� l State: Zip: Cil b
Contractor J �j
Name: A (VZ. id 02_,0
Phone: qa'
b '7333 Fax: S3s----.65.,;-‘'
Address: SS)7 0 (rI>?a 0,i0 City: Sae) -w-t State: L - Zip:9921 Z
License No: IA l 2' .1)...1., 290-J3 City Business Lic:
Contact
Name: SL Phone: (�0 _7,333
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 C X $12.00 = 12. CO
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 = /, '''u
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 = /Z• c'd
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 2 T.o1J
❑CASH 0 CHECK ❑VISA 0 MC EXPIRES: PROCESSING FEE L$35.00
CARD#: VIN: TOTAL PERMIT FEE DUE: 6 c.,-).0t)
AUTHORIZED SIGNATURE:
REVISED 8/26/05