2004, 07-02 Permit App: BLD-04-07014 Mechanical Fixtures MECHANICAL PERMIT APPLICATION
ci[t't>f City of Spokane Valley Community Development Department
1�"'""__ SuildingDivision
J7J elle 11707 E. Sprague Avenue, Suite 106
y Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: /,c&0 9 1/ Permit Use:
Owner: 13 Cl .0 al i AD 41 Phone (Daytime Contact):
Mailing Address: /�6,.n 9 %i - S 06 a/iia 1t) City U i/7 y 10 smote 970 p Code
Contractor: /14 TA License#: Phone#: i '3 4' zoyz
Mailing Address:
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORKUNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 X X , $15.00 =
2 FUEL BURNING APPLIANCE More than 100,000 X $19.00 =
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 =
USED APPLIANCE(WSEC min.AFUE X $� _
5 rating) Equal to or less than 400,000
USED APPLIANCE(WSEC min.AFUE )( $100.00 =
6 rating) More than 400,000
7 BOILER/REFRIGERATION 1-100M BTU X $15.00 =
8 BOILER/REFRIGERATION 101-500M BTU X $28.00 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $39.00 =
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $57.00 =
11 BOILER/REFRIGERATION More than 1,750M BTU X $95.00 =
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 .K X $10.00 =
16 MISC.FUEL BURNING APPLIANCE X _ $10.00
17 GAS PIPING(each outlet) ,k 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 $19.00 =
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 3-15 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 =
METHOD OF
PAYMENT: J /` SUBTOTAL
0 CASH $CHECK 0 VISA 0 MC DATE: 7/2/V`7 PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: