2003, 12-05 Permit App: BLD-03-03213 Insert, Piping •
c1TY c 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
► �3oKane Spokane Valley,WA 99206 509-688-0037-Fax
,,,,,,•' Val ley
•Mechanical Permit Application
PROJECT PERMIT
ADDRESS: 113/7 /*7/ USE:
OWNER: S pZ G.„-:-__Cy / ci c t-r PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE#:
MAILING ADDRESS: -' PHONE#:
(street) (city/state) (ZIP)
DESCRIPTION OF WORK 8 OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE -OR<100,000 X ' $15 =
2 FUEL BURNING APPLIANCE >100,000 X $19
3 UNLISTED APPLIANCE(ADDITIONAL FEE) =OR<400,000 X $90
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 =
5 USED APPLIANCE(WSEC min.AFUE rating) =or<400,000 X , $50 -
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 =
7 BOILER/REFRIGERATION 1-100M BTU X $15 -
8 BOILER/REFRIGERATION 101-500M BTU X $28 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $39 -
10 BOILER/REFRIGERATION 1001-1,750M BTU X . $57 -
11 BOILER/REFRIGERATION +1750M BTU X $95 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE - ( X $10 - y�0
•
13 RANGE - X $10 7
14 DRYER - X $10 -
15 FUEL BURNING WATER HEATER - X $10 -
16 MISC.FUEL BURNING APPL. - X $10 -
17 CAS PIPING(ea.Outlet) - ' X $1 - .f'
18 DUCT SYSTEMS - X $10 -
19 VENTILATING FANS - X $10 -
20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM X $19 -
22 EVAPORATIVE COOLERS - X $10 _
23 TYPE I HOOD - X $50 -
24 TYPE II HOOD - X $10 -
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 -
26 AIR CONDITIONER 3-15 TON X $20 -
27 AIR CONDITIONER 15-30 TON X $25 -
28 AIR CONDITIONER 30-50 TON X $35 -
29 AIR CONDITIONER +50 TON X $60 -
30 LPG STORAGE TANK - X $10 .
31 WOOD OR PELLET STOVE/INSERT - X $10 -
32 WOOD STOVE-FREE STANDING - X $25 -
SUBTOTAL: I C°
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
VISA • V1s1 TOTAL PERMIT FEE DUE
❑ CASH ❑ CHECK ❑ iiiiiigni ❑ ' ,
DATE: EXPIRES:
BANKCARD NUMBER.:
AUTHORIZED SIGNATURE: