2007, 11-14 Permit App: 07004539 Insert, Piping ,�/N Permit Center
i a a �a 11703E Sprague Ave,Suite B-3
Spokane Valley,WA 99206 q
Ol de PERMIT NUMBER: ki G 3 1
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4//f`�Valle (509)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development N�'��'wspokanevallev.org
Mechanical Permit Application j n Commercial g Residential
SITE ADDRESS: / '\r1C' C'>0 d Ru i I' `t�ci 5 P9b KG' /'l& \/o j. 4 t,7,
Building Owner ,may
Name/,C'C.0 S C. LPA t/L, r Phone: ?1-r D 7 s.4- Fax: N A
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Address. /( 5 vv CJ v cl RG e.,__,,_. feel- Crty.5-p e r► 4, \427
4t. 0 State: r�A Zip: y ?.2_,:i6
Contractor
Name: 5 A A 5 a h ry v-17 Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact e c..e_.,c'5, c 05ni2art 51,Z( .._ 0 7 ' C
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 I 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) j 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
'CASH ElCHECK ElVISA 0 MC EXPIRES: PROCESSING FEE $35.00
CARD#: VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE (7_,,-
REVISED 8/26/05