2004, 03-05 Permit App: BLD-04-03698 Water Heater 4
3pohaneMECHANICAL PERMIT APPLICATION
CUM al"11114
City of Spokane Valley Community Development Department
BuildingDivision
leY 11707 E. Sprague Avenue, Suite 106
40,Val
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: / I *0-, ' Permit Use:
Owner: LO i LI--i a-114 '' . (om'( , C Pone (Daytime Contact):
Mailing Address: 1 jq/a L- 5pate0-/TAT VA-)4y ei Gd
City ( / s State Zip Code
Contractor: License#: Phone#:
Mailing Address:
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 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(VIISEC min.AFUE
5 rating) Equal to or less than 400,000 X $50.00 =
USED APPLIANCE(WSEC mire.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 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 1 e�Ck X $10.00 = 1 0, O d
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 Il 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 =
METHOD OF PAYMENT: SUBTOTAL
ElCASH 0 CHECK 0 VISA Q MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: