2003, 10-28 Permit App: BLD-03-02921 Mechanical Fixtures SCITY c 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
pokane Spokane Valley,WA 99206 509-688-0037-Fax
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Mechanical Permit Application
PROJECT PERMIT
ADDRESS: Jr ��`
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OWNER: 5Y/ Sf fr PHONE(Daytime Contact):
MAILING ADDRESS:
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(street) (city/state) ZIP)
CONTRACTOR: y, / LICENSE It:
MAILING ADDRESS: PHONE It: -
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(street) (city/state) (ZIP)
DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 X ' $15 - /5'''r"--
2 FUEL BURNING APPLIANCE >100,000 X $19 =
3 UNLISTED APPLIANCE(ADDIITONAL 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 = L
13 RANGE - X $10 =
14 DRYER - X $10 =
15 FUEL BURNING WATER HEATER - - X $10CZ
16 MISC.FUEL BURNING ADPL, - - X - $10 _
17 GAS PIPING(ea.Outlet) - X $1 =
o7
18 DUCT SYSTEMS
- X $10 =
19 VENTILATING FANS - X $10 =
20 AIR HANDLER(DOES NOT indude 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
VISA " � � TOTAL PERMIT FEE DUE:
❑ CASH ❑ CHECK CI ❑ L._ .,1-17 4
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE: