2005, 01-06 Permit App: 05000057 Insert, Piping I i (6 �. C
A MECHANICAL PERMIT APPLICATION Community Development Department
Building Division
JJ_'� Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
dir*June
For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: /D ' 1 / 4 _ Permit Use:
Owner U I ( 1 Phone (Daytime Contact):
Mailing Address, /O;a/6 if r IA ) F1 t' - slate zw code
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Contractor: 1—Orly`� jcity-� � cc n License#: 5 e.b6s-t-AO.).c2rb Phone#: 99 Ll 6,3Ly
Mailing Address:
C4, 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 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 = In I . J
13 RANGE X $10 00 =
14 DRYER X $1000 =
15 FUEL BURNING WATER HEATER X $10.00 =
16 MISC. FUEL BURNING APPLIANCE . X $10.00 =
17 GAS PIPING(each outlet) 1 X $1.00 = /• U 0
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 I i U 0
❑CASH C:1CHECK ❑VISA 0 MC DATE: PROCESSING FEE $35.00`/
EXPIRES
CARD# TOTAL PERMIT FEE DUE: /�-6,
AUTHORIZED SIGNATURE