2004, 12-07 Permit App: 04009336 Mechanical Fixture 04r. /q3
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MECHANICAL PERMIT APPLICATION
Sallaandli"\161141e City of Spokane Valley Community Development Department
BuildingDivision
1'1707 E. Sprague Avenue, Suite 106
40,,fey - Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
/ ��,,3 �� �Q,�„~� L FOR INSPECTIONS, CALL(509) 688-0054
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Project Address: 7 , ' Permit Use:
Owner: ,4,4' T/A) ffiAL--LS Phone(Daytime Contact):
..Mailing Address: /4 . S'/ 3 6- -ze,77/ c..>il -,,,,-- (1)41- C93 -7
City _ State Zip Code
Contractor: OWet ' I JC License ft: in
: OlP/93i 1/ Phone#: 4/6-7-6 ti rd
Mailing Address: __I 3 706, (.42 , :) S p,r�N Wi4- 9 9 z 6
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 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 raang) Equal to or fess than 400,000 X $50.00 =
USED APPLIANCE(WSEC miry AFUE
8 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 BOILER/REFRIGERATION 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 = '
• 46 MISC.FUEL BURNING APPLIANCE i 4/1616-Yr/OW)AIV/ / X S10.00 =
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 CEM 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 PUMPIAIR CONDITIONER a-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 560.00 =
30 LPG STORAGE TANK • X $10.00 =
31 WOOD OR PELLET STOVEFlNS€RT X $10.00 =
32 WOOD STOVE-FREE STANDING X $25.00 =
METHOD OF PAYMENT: SUBTOTAL
❑CASH 0 CHECK 0 VISA Q MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES. TOTAL PERMIT FEE DUE /
AUTHORIZED SIGNATURE: