2003, 12-22 Permit App: BLD-03-03325 Insert, Piping SSCITY c 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
pO ;ane Spokane Valley,`WA 9'9206 509-688-0037-Fax
,,,. Valley For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT ))
ADDRESS: H2- 11 E S/ -F' USE:
OWNER: J G ,Z G i P So PHONE(Daytime Contact): 9,! 3?3 co
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: Q &r /I 1 . J LICENSE It: O6, L4�,{4 0 3 J
MAILING ADDRESS: / �f LA T L / PHONE It: (Ick Z �t"lZ
47
I Z°12-i -rvx.kK g Sier 0 e Jett L.< y �.� g ?a.,I G
(street) (city/state) (ZIP)
DESCRIPTION OF WORK 9 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 - I X $10 - I 0
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) - i X $1 = ( 0 a
18 DUO'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: (t "J
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
Mini` • i} 4-' TOTAL PERMIT FEE DUE °
0 CASH ® CHECK 0 0 L...._....-2.'n:Y'_ ��
DATE: EXPIRES:
BANKCARD NUMBER:
r7
AUTHORIZED SIGNATURE: 6