2011, 05-04 Permit App: 11001157 Mechanical Fixtures ` Permit Center
S�`okane 11707E Sprague Ave,Suite 106 t i �' (5 PERMIT NUMBER:
p Spokane Valley,WA 99206 i i Li ,_
4. 00Valley- (509)688-0036 FAX:(509)688-0037
Community Development www'.spokanevalley.ore PERMIT FEE:
Mechanical Permit Application n Commercial ❑ Residential
SITE ADDRESS: 12_CL2c ,t,, 1/it i 1 GA'� 9 li.:2 i Z
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Building Owner
Name: + jtjPhone: !' i Fax:
Address: 2,92q L. >, City: - ,))l4-j r1 Lt.-- State: ii L'1"A Zip: 29_Z/G
Contractor
Name: \. 1 7\ Phone: Fax:
1 1I IC-- Yiit.) t/cod ,_733 5 3S- 66, 6
Address: c-5(7 6.-,... Iv1),1.(v.iJ CIS' j c,i) State: L✓!, Zip: .;c2/ Z
License No: i;',)t tZ ..1.. It(I it> City Business Lie:
Contact
Name: Phone: 9-5'9- S- '2'4/j 4/
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 I X $12.00 = /2-C'\
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 X $10.00 =
13 RANGE X $10.00 =
14 DRYER X $10.00 =
15 FUEL BURNING WATER HEATER ( X $10.00 = ie. :-,i
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) 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 y X $12.00 = i?
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 ' 4.1.t ,'
❑CASH ❑CHECK 0 VISA 0 MC EXPIRES: PROCESSING FEE $35.00
CARD#: VIN: TOTAL PERMIT FEE DUE: 1•7.
AUTHORIZED SIGNATURE:
REVISED 8/26/05