2005, 11-03 Permit App: 05004169 Insert, Piping Permit Center
"" 11707 E Sprague Ave,Suite 106 ] I Le
poka`n�e' Spokane Valley,WA 99206 PERMIT NUMBER: ,�{ l
vl� (509)688-0036 FAX:(509)688-0037._ •
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Communi Development PERMIT FEE: ./I Le
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Community P www.spokanevallev.or_com
Mechanical Permit Application n Commercial [A Residential
SITE ADDRESS:_ 13 16 O % E 17.4'"' A v S p c`,G,G,'s
Building owner A I%4 i. S VN Q‘n.)C
+� • to Lotr
Name: AU l qM s%es ,('k W CAN.,„ti l Phone: $ai 2,- 3 g y 0 Fax:
Address: ( 1 $4 S E. 1Z ^1-v. A e City: 4 p d+ :iv State: 144,EA Zip: Ci q";t-
Contractor
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business License No:
Contact
Name: Phone:
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 X $12.00 =
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 = C/„r`-'"`CTI I 0 UlJ
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 = ( - (./ J
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 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 =
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 1 O s v
- CASH 0 CHECK 0 VISA ElMC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE: 4 5 0 p
AUTHORIZED SIGNATURE: CAS/Q.-J.-vs .Sc),,,,S7AsA.TIr,9,,,,kst)ti REVISED 8/26/05