2005, 08-12 Permit App: 05002914 AC Scm< 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
pota ne Spokane Valley,WA 992'06 509-688-0037-Fax
40000ValleY. For Inspections, call 509-688-0054
Mechanical Permit Application OS - Zai l 4 .
PROJECT PERMIT
ADDRESS; / 9,5�
OWNER j�/ L �� USE: L G 2'l l lU(C y�C_ 4-\
PHO
��'] nn NE(Daytime Contact): j t G2,_-��3 \\,k,,A IV E 4-m(SIV / O
MAILING ADDRESS: C
l s/streef9-)s1 C 1 S DIC--all-tf U►4(�trai 1 WA. 92o3-
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE A:
MAILING ADDRESS: t IC VI?L. �7 9U .
PHONE I:
l i - 733
5517 P\IIO10 S D u1 i (A-f4 °79)-/2.
(street) (city/state) (ZIP)
DESCRIPTION OF WORK 8 OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE -OR<100,000 X 515
2 FUEL BURNING APPLIANCE >100,000 X 519 -
3 UNLISTEIIAPPLIANCE(ADDITIONAL FEE) -OR<400,000 X 550 -
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100
S USED APPLIANCE(WSEC min.AFUE rating) .or<400,000 X $50
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 -
7 BOILER/REFRIGERATION 1-100M BTU X S15 -
8 BOILER/REFRIGERATION 101-500M BTU X $28 -
9 BOILER/REFRIGERATION 501-1,000M BTU X $39 -
10 BOILER/REFRIGERATION 1001-1,750M BTU X . S57 -
11 BOILER/REFRIGERATION +1750M BTU X 595
12 GAS LOG,GAS INSERT,GAS FIREPLACE - X $10 -
13 RANGE - X $10 -
14 DRYER - X 510 -
15 FUEL BURNING WATER HEATER - X 510
16 MISC FUEL BURNING A PPL. - X 510 -
17 GAS PIPING(ea.Outlet) - X S1 -
18 DUCT SYSTEMS - X 510 -
19 VENTILATING FANS - X 510 -
20 AIR HANDLER(DOES NOT Include ducting) -0R<10,000CFM X 512 .
21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM X $19 -
22 EVAPORATIVE COOLERS - X 510 -
23 TYPE I HOOD - X $50 -
24 TYPE II HOOD - X 510 -
25 HEAT PUMP/AIR CONDITIONER 0-3 TON ' X 512 0-
26 26 AIR CONDITIONER 3-15 TON X 520
27 AIR CONDITIONER 15-30 TON X S25 -
28 AIR CONDITIONER 30-50 TON X 535 -
29 AIR CONDITIONER +50 TON X 560 -
30 LPG STORAGE TANK - X $10 .
31 WOOD OR PELLETSTOVE/INSERT - X $10 .
32 WOOD STOVE-FREE STANDING - X 525 -
•
SUBTOTAL: j' •(0
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00�v
MA ��� pj (,
TOTAL PERMIT FEE DUE: Li 7,DLJ
❑ CASH ❑ CHECK ❑ ❑ _'.-��L...�
DATE: EXPIRES: •
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: