2005, 02-04 Permit App: 05000339 Furnace e5 1
/'` MECHANICAL PERMIT APPLICATION Community Development Department
0" t Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: ; , 'A / Permit Use:
Owner: ,. ,MFAI �i " Phone (Daytime Contact):
Mailing Address: ; _ _
' City State Zip Code
Contractor: License#: Phone#:
Mailing Address:
Crty 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 1 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 `;,.., f ;i/ X $100.00 =
1; 1
5 USED APPLIANCE(WSEC min AFUE rating) Equal to or less than 400,000 k��,.'. J,,',1 X $50.00 _
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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 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
0 CASH 0 CHECK 0 VISA 0 MC DATE- PROCESSING FEE $35.00
CARD r EXPIRES. TOTAL PERMIT FEE DUE: SR-�
AUTHORIZED SIGNATURE