2004, 08-31 Permit App: BLD-04-07530 AC MECHANICAL PERMIT APPLICATION
m,011 � City of Spokane Valley Community Development Department
BuildingDivision
alley 11707 E. Sprague Avenue, Suite 106
400111rSpokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
, FOR INSPECTIONS, CALL(509) 688-0054
Project Address: (,SSe1- f: 'Aj/ Permit Use: tJ-r°(' rt rt tx..a
Owner: n+2 >7 t7-4 Phone(Daytime Contact):
Mailing Address: /s a.0 r- (0-37--C101()- ( t,71- l�
City Statei yZip Code
Contractor: /,,7 •l f{1 Gt 7�'icf -d j, License#: "7"h"7"h+/i ' 7 Ph0 e#: �j 3�` 19
Mailing Address: i c- tYi r SSr ,T71 i��`'a I't�. (0-9 q�Jed.
y 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(Addifional 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 miry.AFUE
5 rating) Equal to or less 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 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 =
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 HOOD X $10.00 =
35
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 = / - •IJL
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
❑CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00 {�
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: A
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