2003, 12-01 Permit App: BLD-03-03164 Heat Pump, AC CITY( wMa 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
po- ane Spokane Valley,WA 99206 509-688-0037-Fax
....*Valley
•Mechanical Permit Application
PROJECT PERM
ADDRESS: ! 1-W " ^ C6'rad /al-1 US IT
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OWNER:
/-e C/�,t"�/C0 G`1-/ PHONE(Daytime Contact):
MAILING ADDRESS: / C15 �c
40/ Itie-,-z ....,,)4 A `, 92, 7‘
(street) (city/state) (ZIP)
CONTRACTOR: L.4..i y 1--/(9,6)44,-119 LICENSE#: L y/0--64 9 72 ,//�
MAILING ADDRESS: PHONE#: (5-092
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_51,0e. e //(. t2/
(street) (city/state) (ZIP)
DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 X ' $15 =
2 FUEL BURNING APPLIANCE >100,000 X $19 =
3 UNLISTED APPLIANCE(ADDITIONAL FEE) =OR<400,000 X $50 =
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100
5 USED APPLIANCE(WSEC min.AFUE rating) =or<400,000 X , $50 =
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 =
7 BOILER/REFRIGERATION 1-100M BTU X $15 =
8 BOILER/REFRIGERATION 101-500M BTU X $28 -
9 BOILER/REFRIGERATION 501-1,000M BTU X $39 =
10 BOILER/REFRIGERATION 1001.1,750M BTU X $57 =
11 BOILER/REFRIGERATION +1750M BTU X $95 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE - X $10 =
13 RANGE - X $10
14 DRYER - X $10 =
15 FUEL BURNING WATER HEATER - X $10
16 MISC.FUEL BURNING APPL - X $10 =
17 GAS PIPING(ea.Outlet) - X $1 =
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - X $10 =
20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM X $19 =
22 EVAPORATIVE COOLERS - X $10 =
23 TYPE I HOOD - X $50 -
24 TYPE II HOOD - X $10 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12
26 AIR CONDITIONER 3-15 TON X $20 =
27 AIR CONDITIONER 15-30 TON X $25 =
28 AIR CONDITIONER - 30-50 TON X $35 -
29 AIR CONDITIONER +50 TON X $60 =
30 LPG STORAGE TANK - X $10 =
31 WOOD OR PELLET STOVE/INSERT - X $10 =
32 WOOD STOVE-FREE STANDING - X $25 =
SUBTOTAL:
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
1111011101 —2 VISA' ' sle.f ., TOTAL PERMIT FEE DUE:
❑ CASH CHECK ❑ 111111111111 ❑ —_ ..."- :_i
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: