2004, 08-04 Permit App: BLD-04-07238 AC .- MECHANICAL PERMIT APPLICATION
Po
SiatYl\, City of Spokane Valley Community Development Department
BuildingDivision
40,Wiley 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: 1 [ 1 z -i Et ( 3 'F H , Permit Use:
Owner: 'S't L L NIA N C: v Phone(Daytime Contact):
Mailing Address: „S q }-1& C .S Pis t< I% \J A CZ e.' ' IA)Opt a R o(P
City State` Zip Code
Contractor: L k K \\'V C License#: L K cAE 6 cc i 9i-DRPhone#: a,7 t, . too 0
Mailing Address: Ip '19cl 1_n NC. L.Ke oR , A11A)9 Mt( e 'Fpuuc WO.i 990
City State Zip Code
*OF TOTAL
DESCRIPTION OF WORK _ UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 _ 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
5 rating) Equal to or less than 400,000 X $50.00 =
USED APPLIANCE(WSEC min.AFUE
6 rating) More than 400,000 X $100.00 =
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 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 $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 1 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: SUBTOTAL
❑CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: