2004, 03-10 Permit App: BLD-04-03735 Furnace r
MECHANICAL PERMIT APPLICATION
�,SO ^", ne.10/\4City of Spokane Valley Community Development Department
�'HBuildingDivision
le11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
40,ValY
Phone: (509) 688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: (5ciUZ tit') Permit Use: GIBS roletMGE P-F a 4CEwbur
Owner: Jim C;LtG.Ue,Z Phone (Daytime Contact): �De[-' .-t7- I
Mailing Address: 15°t02- E. (0'
City State Zip Code
Contractor: J.-1M GAP-MAR License#: 6'q to -t 2 Phone#: S(2Z-27o1
Mailing Address: $321 NORA Demiq,UE- oil g4t212-
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 I X $15.00 = 15 0e
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(1/1lSEC min.AFUE
5 rating) Equal to or less than 400,000 X $50.00 =
USED APPLIANCE(WSEC min.AFUE
e-
6 rating) More than 400,000 X $100.00 =
7 BOILER/REFRIGERATION 1-100M BTU X $15.00
B 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 BOILERJREFRIGERATION 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 =
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 $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 =
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 i $25.00 =
METHOD OF PAYMENT: SUBTOTAL I5_00
❑CASH 1t CHECK 0 VISA EI MC DATE: PROCESSING FEE $35.00
EXPIRES: a?
CARD#: TOTAL PERMIT FEE DUE: DC7 -
AUTHORIZED SIGNATURE: / atett3P ..--"ily,7