2007, 10-04 Permit App: 07003968 Gas Piping Permit Center
QQ��,,t�,, `� 11703E Sprague Ave,Suite B-3 -�
�Yie Spokane Valley,WA 99206 PERMIT NUMBER:,` T ,
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(509)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development www.spokanevallev.org '
Mechanical Permit Application ❑ Commercial Residential
SITE ADDRESS:_ C/ / 7 , ICIII'' i� i1_ n ',J
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Building Owner - I,iHILA Ir( / /Q t(
Name: �1Phone: Fax:
Address: ---io I ( [ 100 City:(. Y 1ItA4 State: Uv _ Zip:e:iei 2(2-
Contractor l.t.e t,Gc..-►-4 \ c4 \ * �;�1
Name: Phone: Fax:
Address: Lu L;; \ (,-tom- City: State: Zip:
License No: City Business Lic:
Contact Y\ ��1 t,\ V1/`1.1...\._.A.n;
Name: Phone: 52,tj-0 lS/
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 X $12.00 =
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 =
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) X $1.00 = j
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 X $12.00 =
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
CASH 0 CHECK 0 VISA 0 MC EXPIRES: PROCESSING FEE $35.00
ARD#: VIN: TOTAL PERMIT FEE DUE: _l )
AUTHORIZED SIGNATURE:
REVISED 8/26/05