2004, 03-25 Permit App: BLD-04-03900 Mechanical Fixtures MECHANICAL PERMIT APPLICATION
trIN am ee City of Spokane Valley Community Development Department
Sp() BuildingDivision
Salle 11707 E. Sprague Avenue, Suite 106
�j Spokane Valley, WA 99206
4g, �J Phone: (509) 688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address:- / -0..) 47 /. '
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/ e �e''e -~ Permit Use:
Owner: 775-hc7i.(!�c) f/LP,r /ta Phone (Daytime Contact): 9,26 - 6//l
Mailing Address:
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/ /4..41'
/ City _� State Zip Code
Contractor: ` 4 / Y / ..4 P License#: 27/// ' `1��1f 1 Phone#: ,9?/ c`O 'S----
Mailing Address: '//e% /�. .% //L'e State `�/ Zip Code P �j
City S/D� /fit' 1
#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 = /O
19 VENTILATING FANS X $10.00 , =
20 AIR HANDLER(DOES NOT include ducting) Equal to or less than 10,000 CFM / X $12.00 = /Z
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 X $12.00 -= /2-
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 TANKX $10.00 =
31 WOOD OR PELLET STOVE/INSERTX $10.00 _=
32 WOOD STOVE-FREE STANDING X $25.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH tgl CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
EXPIRES:
CARD#: TOTAL PERMIT FEE DUE: t<7, OD
AUTHORIZED SIGNATURE: h',"/V11;4/(1