2012, 06-18 Permit App: BLD-2012-0903 Mechanical Fixture Permit Center lC)-?C \?_ MOTs
TY�' 11707E Sprague Ave,Suite 106
Sibkane PERMIT NUMBER:
Spokane Valley,WA 99206
Valley+ (509)688-0036 FAX:(509)688-0037 PERMIT FEE: C--- Ci)
Community Development "'�i'��'spokanevallev.ore
Mechanical Permit Application ❑ Commercial krResidential
SITE ADDRESS: I I II 0 It "-
Building Owner
Name: ‘c_IG kt,',-, 1, >�_ Phone: Fax:
Address: L t II 1 e 104..... City: ,pv r_ State: t-vAt- Zip:Z`?Za z
Contractor
Name: 41 L P 0:- 5i3 lLI -1'L T- Phone: clga_7 3 3? Fax:
Address: 5-5--j rvy�L City: 9pole,/1.�tx- State: 1,,,./4„. Zip: 2 p.a/Z
License No: A./4�t...4-� Sg 8 1 b 6 City Business Lic:
Contact
Name: Ti Phone: q 3 a - 73 3 3
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 1 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 $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 =
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 =
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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 !Z H
❑CASH 0 CHECK 0 VISA 0 MC EXPIRES: PROCESSING FEE $35.00
CARD#: VIN: TOTAL PERMIT FEE DUE: 3 7 w
AUTHORIZED SIGNATURE:
REVISED 8/26/05