2005, 11-23 Permit App: 05004454 Mechanical Fixture �� Permit Center
S�"" ne 1 1 707 E Sprague Ave,Suite 106 c/ �
ley Spokane Valley,WA 99206 PERMIT NUMBER
(509)688-0036 FAX:(509)688-0037
' PERMIT FEE:
Community Development www.sookanevallev.ore.com
Mechanical Permit ApplicationJ , ❑ Commercial „residential
SITE ADDRESS: /41// S. LJ \ ,C
Building owner
Name: C 1 /i,2.2/Tit ) A///7N1#`/ `b Phone:i;if, 6, C Fax: -)
Address: //c/// „..„5,.... 6z2/Z.ts��i� f/ i''.. Ci irnn',s Y /7-l6� (i State: /,-,/.4- Zip:f f :),Lo
Contractor /
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business License No:
Contact
Name: Phone:
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 / X $12.00 =
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 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 =
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: _ DA /6963 -CS-)S SUBTOTAL
OCASH 0 CHECK I VISA 0 MC -.. PROCESSING FEE $35.00
CARD# ' ; EXPIRES: TOTAL PERMIT FEE DUE:
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AUTHORIZED SIGNA A ,t.. ' A! '. , _g/. , L, REVISED 8/2W05