2004, 12-06 Permit App: 04009312 Furnace 0L ,-A 'w q.:5'
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/� MECHANICAL PERMIT APPLICATION Community Development Department
$okanI°' ` Building Division
�I�py Phone: (509)688-0036; FAX: (509) 688-0037 (C1 E.E. Sprague Avenue, Suite 106
'"'"`, For Inspections, Call(509)688-0054 Q Z 2CP Spokane Valley, WA 99206
Project Address: ( J ( / S - 'D-7 Permit Use:
Owner: `--e0b7.\ 'T.:Sc5-A-✓1- 5-Poke
Ph a aytime Contact): g��
Mailing Address: w. �}
City �./ State Zip Code
Contractor: 71 ` 7- S45 q _---i y) 1� ATI/License#: � ER A-Co 5 S,l'B Phone#: S--E35' -? 31'-G• -Z 3
Mailing Address:
City State Zip Code
DESCRIPTION OF WORK #OF UNITS X COST , = TOTAL AMOUNT M
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 I 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) 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 $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
0 CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: 7
TOTAL PERMIT FEE DUE: / ,
AUTHORIZED SIGNATURE: