2006, 10-25 Permit App: 06004281 Piping Permit Center
I'"kine 11707 E Sprague Ave,Suite 106
• 7 Spokane Valley,WA 99206 PERMIT NUMBER:
......Valley (509)688-0036 FAX:(509)688-0037 {{ �`,Z�
Community Development wwwv.spokanevallev.ore PERMIT FEE: .�" J
1.
Mechanical Permit Application ❑ Commercial al 'esidential
SITE ADDRESS: \t
Building Owner
Name:()��. ) Phone: Fax:
Address: C City:\ �A�l U State: j_�rl TNC) Zip:
15 at , t, :fa
1
Contractor
Name: �c ntu t 7 ,, 003'hone:(,.)`7_ I loch Fax:( ) 777_9
Address ) ,'ll Lk City.�QlS i- ((1/1 115 State: !4 hn Zip �c�lJ 7 /
License No: i\I \ City Business Lic:
Contact 1
Name: Phone:
DESCRIPTION OF WORK #OF UNITS I 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 =
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) 1 X $1.00 = I °C-0
18 DUCT SYSTEMS X $10.00 =
19 VENTILATING FANS X I $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
OCASH CHECK ❑VISA 0 MC EXPIRES: PROCESSING FEE $35.00
CARD#: VIN: TOTAL PERMIT FEE DUE: SO„C('
AUTHORIZED SIGNATURE:
REVISED 8/26/05