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2004, 08-24 Permit App: BLD-04-07435 Duct System TO'3JlId SOS Tb8b60S 9S:0T b00Z 0T 9fld , City of Spokane Valley Mechanical Permit Application Fax*888-0037 Project Permit Address: 11205 E 4th Use: Owner. Dan Hultquist Phone(daytime contact): 994-0080 Mailing Address SAME (street) (city/state) (zip Contractor. R&R Heating and AC,inc. License: RRHEAA106BW Mailing Address 4019 E Central Phones: 484-1405 Spokane,We 99217 (street) (city/state) (zip) Description of Work I of units , Cost _ = Amount 1 Fuel burning appliance -or<100,000 X 15.00 = 0.00 2 Fuel burning appliance >100.000 X 19.00 = 0.00 3 Unlisted appliance(additional charge) -or<400,000 X 50.00 = 0.00 4 Unlsted appliance(additional charge) >400,000 X 100.00 = 0.00 5 Used appliance(WSEC's miry.AFUE rating) -or<100,000 , X 580.00 = 0.00 6 Used appliance(WSEC'e min.AFUE rating) _ >400,000 X 100.00 = 0.00 7 Boiler/refrigeration 1-100M BTU X 15.00 = 0.00 ^ 8 Boiterlrefrigeration 101-5500M BTU X 28.00 = 0.00 9 Boller/refrigeration , 501-1.000M BTU X 39.00 = 0.00 10 Boilerlrefrigeration 1,001-1,750M BTU X 57.00 = 0.00 11 Boilerlrefrigeration +1,750M BTU X 96.00- @ 0.00 12 Gas log.gas insert.gas fireplace - X 10.00 = 0.00 13 Range - X 10.00 = 0.00 14 Dryer - . X 10.00 = 0.00 15 Fuel burring water heater - X 10.00 = 0.00 16 Miscellaneous fuel burning appliance - X 10.00 so 0.00 17'Gas piping.(each outlet) - X 1.00 = 0.00 18 Duct systems - 1 X 10.00 = 10.00 19 Ventilating fans - X 10.00' = 0.00 20 Air handler(does not include ductin.) -or<10,000 CFM X 12.00 = 0.00 2t Air handler(does not Include ducting) >10.000 CFM X 19.00' = 0.00 22 Evaporative coolers - X 10.00 = 0.00 23‘Type I hood - , X 50.00 = 0.00 24 Type II hood - X 10.00 it 0.00 25 Heat pump/air conditioner 0-3 tons X . 12.00 = 0.00 26 Air conditioner 3-15 tons X 20.00 = 0.00 27 Air conditioner 15-30 tons X 25.00 = 0.00 28 Air conditioner 30-50 tons X 35.00 = 0.00 29 Air conditioner +50 tons X 60.00 = 0.00 30 LPG storage tank - X 10.00 = 0.00 31 Wood or pellet stove/insert - ' X 10.00 = 0.00 32 Wood stove-free standing - X 25.00 =I 0.00 0 Cash 0 Check 0 Visa 0 MasterCard Subtotal 10.00 Faxed permits will only be aoceptea with payment of a major credit card Plus Processing Fee 35.00 Date: Expires: Total Permit Fee Due 45.00 - Bankcard Number Authorized Signature: 01(4 3 TO/TO Sid SNI1ti3H ieI2i SOStb8b60S tb:0t 000Z/0t/80