2005, 06-23 Permit App: 05002144 AC MECHANICAL PERMIT APPLICATION Community Development Department
waneane Building Division
«a' Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
1 / For Inspections, Call (509) 6880054 ' Spokane Valley,WA 99206
Project Address: -,19/(19 25 /3' Permit Use: 05-- 2-) L_
'
Owner. /VA-iv /t: 77,rAQ. Phone (Daytime Contact):
Mailing Address:
i. City State Zi de
Contractor: 4.._AZ et-cc a >.,r /(' License#: Phone#: v73-:9 '7- J Co
Mailing Address: /g,-,>. id..,2 AO*, ',A✓;, / -73 8g7
City State Zip Code
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 1,75DM BTU X $60.00 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE X $10.00 =
13 RANGE X $10.00 =
14 DRYERX $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 3-15 TON X $20.00 =
27 AIR CONDITIONER 15-30 TON X $25.00 = Z..5.
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 =
G
METHOD OF PAYMENT: SUBTOTAL G 6• D
DATE:
0 CASH 0 CHECK giVISA 0 MC PROCESSING FEE $35.00
CARD#: EXPIRES: _
TOTAL PERMIT FEE DUE: 7.06
AUTHORIZED SIGNATURE: Ano