2005, 01-31 Permit App: 05000275 Water HeaterSan < 1 . 11707 East Sprague A, enue, Suite 106 509-688-0036 - Phone
po1ane Spokane Valley, WA 99206 509 -688 -0037 -Fax
40;jUalley
Mechanical Permit Application
PROJECT
SOF=S X
Fls M
AhfOl➢YI
1 FUEL BURNING APPLIANCE
ADDRESS: ) `
Q�
115
USE:
Z FUELBURNINGAPPLUNCE
_
OWNER'.
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PHONE(Day-time ContaR):
•OR,",M1
X
350
< UNLUGED APPLIANCE(ADDITIONAL FEE)
>MAA
%
MAILING ADDRESS:
5 USED APPLIANCE(W$EC mn. ARE nMnB)
a Kav
%
f3p
6 USED APPLANCE(WSEC mirt AFUE vtlng)
a1W,W]
X
(Street)
(city/Sfdte)
F BOILEWREFRIGERATION
(ZIP)
x
CONTRACTOR: F d
S BOILER/REFRICERATION
LICEN I.
[�G�
p /
G
MAILING ADDRESS
9 BOUER/REFWGEEAVCN
PHONES:
%
S39
10 BOMFR/AEFRIGERATION
10%-1,750M BN
9 �j
Z
$57
II BOREKTIEFRIGERATION
C 1Jf�
%
g
(street)
(aty/state)
(Z�)
510
METHOD OF PAV
❑ CASH
DESCRIPFTONOFWORR
SOF=S X
COST EQIW.S
AhfOl➢YI
1 FUEL BURNING APPLIANCE
.OR a 1W.*X
%
115
Z FUELBURNINGAPPLUNCE
>IM x*
X
fl9
3 UNLISTED APPLIANCE (ADDITIONAL FEE)
•OR,",M1
X
350
< UNLUGED APPLIANCE(ADDITIONAL FEE)
>MAA
%
S1W
5 USED APPLIANCE(W$EC mn. ARE nMnB)
a Kav
%
f3p
6 USED APPLANCE(WSEC mirt AFUE vtlng)
a1W,W]
X
31W
F BOILEWREFRIGERATION
I -IWM BN
x
f15
S BOILER/REFRICERATION
101 -SSM anI
- X
$28
9 BOUER/REFWGEEAVCN
WI-1,W3M BN
%
S39
10 BOMFR/AEFRIGERATION
10%-1,750M BN
X
$57
II BOREKTIEFRIGERATION
1750 BN
%
f95
12 GAS LOC, CAS INSERT, OAS FIRE PL ACE
X
510
u RANGE
X
110
14 DRYER
X
310
15 FUEL BURNING WATER HEATER
%
fI0
0
16 KLEC FUEL BURNING ADPL.
%
f10
11 GAS 1.11"ee. 0u.,O
%
$1
1B DUCT SYSTEMS
X
f10
19 VENTILATING FANS
X
fRl
M AIR HANDLER(WES NOTI-lude during)
-OR,101 CFM
x
Sl3
11 MRHANDLER DOEENO IL I dedu ,,
, 101= CFM
X
119
2a EVAPOMTIVECOOLERS
X
510
23 TYPE I HOOD
N TYPEIBHOOD
X
flp
R5 HEATPUMPIAIRCONDIITONER
S-3 TON
X
SI3
26 AIRCONORIONER
}IS TON
X
110
27 AIRCONDIfIONER
153)TON
X
f]5
0E AIR CONDITIONER
3650 TON
29 AMCONDMONER
WTON
W LPG STORAGE TANK
31 WOOD OR PELLET SFOVEANSERI
X
510
32 WOODSTOVE-FREESTANDNC
X
525
TIENT
r _
SUBTOTAL
PLUS PROCESSING FEE:
- TOTAL PERMIT FEE DUE:
§35.00
❑ CHECI
DATE
BANKCARD NUMBER _
AUTHORIZED SIGNATURE:
EXPIRES: