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2004, 12-01 Permit App: 04009150 Furnace tiO'30tid SOS Tb8b60S ZS:bT vow ZO nON \6t CA City of Spokane Valley Mechanical Permit Application Fax#688-0037 Project Permit Address: 12005 E 9th Use: Owner: Shane Opsal Phone(daytime contact): 924-0772 Mailing Address SAME (street) (city/state) (zip) Contractor: R&R Heating and AC, Inc. License: RRHEAA106BW Mailing Address 4019 E Central Phone#: 484-1405 Spokane,Wa 99217 (street) (city/state) (zip) Description of Work #of units _ Cost ' 4 Amount 1 Fuel burning appliance -or<100,000 1 X 15,00 = 15.00 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 Unlisted appliance(additional charge) >400,000 X 100.00 = 0.00 5 Used appliance(WSEC's min.AFUE rating) - -or<100,000 X 580.00 = 0.00 6 Used appliance(WSEC's min.AFUE rating) >400,000 _ X 100.00 = 0.00 7 Boller/refrigeration 1-100M BTU X _ 15.00 = 0.00 8 Boiler/refrigeration 101-500M BTU X 28.00 = 0.00 9 Boiler/refrIgeration 501-1.000M BTU X 39.00_ _ 0.00 10 Boiler/refrlgeration 1,001-1.750M BTU X 57.00 = 0.00 11 Boiler/refrIgeration +1,750M BTU X 95.00 = 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 1_ 15 Fuel burning water heater - X 10.00 = 0.00 16 Miscellaneous fuel burning appliance - X 10.00 = 0.00 17 Gas piping,(each outlet) - X 1.00 = 0.00 18 Duct systems - X 10.00 = 0.00 19 Ventilating fans - X 10.00 = 0.00 20 Air handler(does not Include ducting) -or<10,000 CFM X 12.00 = 0,00 21 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 11 hood - X 10.00 = 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 - X10,00 = ' 0.00 31 Wood or pellet stove/insert - X + 10.00 = 0.00 32 Wood stove-free standing - X 25.00 = _ 0.00 - _ ❑ Cash 0 Check Cl Visa Cl MasterCard Subtotal �_ 15.00 Fazed permits will only be accepted with payment of a major credit card Plus Processing Fee 35.00 Date: Expires: Total Permit Fee Due 5 . 0 Bankcard Number: t , Authorized Signature: L_ 1 ,6 TO/TO 39VcI 9NI1l73H elel SOSTtBb6OS EE:ST b00Z/ZO/TT