2007, 12-06 Permit App: 07004790 Mechanical Fixtures S
Permit Center
�� 11703E Sprague Ave,Suite B-3 9p7 r0
S Okane PERMIT NUMBER: / C/
P Spokane Valley,WA 99206
4000 Valley (509)688-0036 FAX:(509)688-0037 PERMIT FEE: 5)
Community Development st-wtivspokanevalley.or,
Mechanical Permit Application 9) ❑ Commercial Residential /�s�
SITE ADDRESS: 72 L''2 3 1/ TA' S f 6 imPiri V19 L'L %.2).2
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Building Owner n �+ ,J �^ p�
Name: ),y7 w.^l t7-�e g J in
,r`' Phone: 9�J d J3/2 Fax:
Address: '/2 .. ri ii
ra City: S /Qi(1.A ki 4.y t)State: ,, 4 Zip: 9'92 J z
Contractor w
Name: Phone: Fax:
Address: .0 J d t City: State: Zip:
License No: City Business Lic:
Contact /J M /`' Q�
Name: (filo OL G f p i err/ Phone: 9 ,/ O I
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 / X $12.00 = )2
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 I $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 = JO
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 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 .2 Z
❑CASH 0 CHECK 0 VISA 0 MC EXPIRES: PROCESS G FEE $35.00
1 60
CARD#: _. VIN: TOTA »; IT FEE DUE: rJ
AUTHORIZED SIGNATU' : ,0i i it// //,i iv'
REVISED 8/26/05 ii � / '