2006, 11-07 Permit App: 06004435 Mechanical Fixtures Permit Center
"'`r 11707E Sprague Ave,Suite 106
Spokane PERMIT NUMBER: q ti g 5-
Spokane Valley,WA 99206
/f Dalley (509)688-0036 FAX:(509)688-0037 PERMIT FEE: 5-/
Community Development www.spokanevallev.ore
Mechanical Permit Application�jn❑ Commercial 1 Residential
SITE ADDRESS: ,< 5 / Z �6 t- ..4 . J n/c..-.- Vim•7CCt, / (/t/4 / f0 7
Building Owner
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Name: (y A7-/�t� Phone:(jd`/� !2/ -��O
Address: / City: r 11 State: �✓i Zip: 7 foy �?
l S r 2 F /G ..,.c ,- -70 �c r..-t Cf. /
Contractor
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact
Name: , f ., ,¼e.-. Phone: 5n 2/ - T4 G o
DESCRIPN 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 SEC min.AFUE ratin ) Equal to or less than 400,000 X $50.00 =
6 USED ... ) 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 ductin ) Equal to or less than 10,000 CFM X $12.00 =
21 AIR HANDLER(DOES N• 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
❑CASH 0 CHECK 0 VISA 0 MC
EXPIRES: PROCESSING FEE $35.00
VIN:
CARD#: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05