2004, 09-08 Permit App: BLD-04-07584 Furnace, AC MECHANICAL PERMIT APPLICATION
* e Citof Spokane Valley CornmunitY Development Department
BuidingDivision
11707 E. Sprague Avenue, Suite 106�eV •
40,
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: j� g Permit Use:
Owner. 61. 1Z y Al.oo•z.6 Phone(Daytime Contact):
Mailing Address:
City State Zip Code
Contractor: 1-7 License#: Phone#: C 3 6,:V
Mailing Address: Po "lox "/ 3 6 3 5,0 0/ qs Z ee_
City State Zip Code
#OF j TOTAL
DESCRIPTION OF WORK !l UNNIITSS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 l l_ X $15.00
2 FUEL BURNING APPLIANCE Mare 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(WSEC min.AFUE
5 rating) Equal to or fess than 400,000 X $50.00
USED APPLIANCE(WSEC min.AFUE
6 rating) More than 400,000 X $100.00 =
7 BOILER/REFRIGERATION 1-100M BTU • X $15.00
8 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 BOIL€RfREFRIGERATION 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 HOODll X $10.00 =
25 HEAT PUMP/AIR CONDITIONER • 0-3 TON l , / 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 =
3.1 WOOD OR PELLET STOVE/INSERT X $10.00 =
32 WOOD STOVE-FREE STANDING X $25.00 =
METHOD OF PAYMENT: SUBTOTAL
I]CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
•
AUTHORIZED SIGNATURE: Q