2009, 12-30 Permit App: 09004121 Mechanical Fixture Permit Center
>> jp'- 11 Sprague Ave,Siete 106 PERMIT NUMBER. l
-• 5.,� Valley,WA 99206
,®/ (509)688-0036 FAX (509)688-0037 PERMIT FEE: v-.)0-
Community Development www.spolcanevallev.or2
Mechanical Permit Application El Commercial > idential
SITE ADDRESS: /2 5 E !
Belldhng Owner (� `�` l f ('1t `
Name: /� Phone: C 2 6 I'� Fax:
Address: CY 6 tr T�,C /. City.S("), IL a pj ,ic i'Cq State Tap. f .`:',/
co-ft-tor/3,4- 'L REGI pv 0, f Co Nd r a,4f f- I
Name: Phone:R2 7_996 ( Fax SL.t+lt''-Q.
Address: ! t/1,(t,.. e,- .a-6,4l, so Sittiefet44,fit, tk fat'�r State: LAJ °, 't eta
License No: gr.._ ,t'l 0; �"'i `0 p g I City Business Lic: /
Contact' Ch a tt
Name: Phone: -7 l v _z i,y 44 C e/f --
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal lo or less than 100,000 / X $12.00 = I ?0 LJ
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 nein.AFUE rating) Equal lo or less than 400.000 X $50.00 =
8 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 $80.00 =
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 510.00 =
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 PUIV'IAIR 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 / '•00
OCASH 0 CHECK )]VISA ElMC EXPIRES: PROCESSING FEE $3Y.00
CARD i3 VIN. TOTAL PERMIT FEE DUE: 2-/CI•CSD
AUTHORIZED SIGNATURE:
REVISED sr26ro5