2005, 03-22 Permit App: 05000852 Heat Pump, AC 0 cs.--____ gs„,..;_.
MECHANICAL PERMIT APPCICATION Community Development Departmen
ern a Building Divisior
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 10E
For Inspections, Call ( 09) 688-0054 Spokane Valley, WA 9920E
Project Addres: 0 . a 9 !
• Permit Use:
Owner: %' rA_v\rka 1 l o ✓1 0 vl Phone (Daytime Contact): ei,i 4 - b'A D 7
Mailing Address: 5 a vvt Q J11cl'ra.n, V11/ W el q(36())
ttyState Zip Code
Contractor: III $ Ll • LA . . icense#: 1.41_30Al CC5 - • Phone#: <I hi, "311/
Mailing Address: l D-2 AJ , L06-tfSJ- Sic, p,,,, r11tf 1n) ,... Qgaci
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DESCRIPTION OF WORK #OF UNITS X COST l = 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 1,750M 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 = y
25 HEAT PUMP/AIR CONDITIONER 0-3 TON • \ X $12.00 = I C_,
• 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
DATE:
f 0 CASH 0 CHECK 0 VISA ❑MC PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE: ")'7,
AUTHORIZED SIGNATURE: