2003, 11-24 Permit App: BLD-03-03143 Wood Stove CITY t 11707 East Spgue Avenue,Suite 106 509-688-0036-Phone
► pO. .ne i aSpokane Valley,WA 99206 509-688-0037-Fax
,,,0.0Valley
Mechanical Permit Application
PROJECT , /� G r PERMIT
ADDRESS: I'f 011 • T� A ye_ , USE:
OWNER:Q 1rI elPHONE(Daytime Contact):
I,1/aY ia•k 549- y9/.. 320y
MAILING ADDRESS:
/8I0 . 971 ,Q,, 6Yeengcues iv 4. 9`IOI6
(street) (city/state) (ZIP)
CONTRACTOR. LICENSE#:
MAILING ADDRESS: -• PHONE#:
(street) (city/state)
(ZIP)
DESCRIPTION OF WORK F 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 - X $10 =
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) - X $1 =
18 DUCT 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 CONDMONER 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 - 1 X $25
SUBTOTAL:
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
rVaSlEif.. TOTAL PERMIT FEE DUE:
❑ CASH ❑ CHECK ❑ MX= ❑ •..._ '_
DATE: I/-21t-03 EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: £'t,I , Jv'/
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