2004, 07-09 Permit App: BLD-04-07042 AC MECHANICAL PERMIT APPLICATION
SLIASlieme\bCity of Spokane Valley Community Development Department
BuildingDivision
Valle
11707 E. Sprague Avenue, Suite 106
n41, ue, SuValley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
' FOR INSPECTIONS, CALL(509)688-0054
Project Address: 7(1 7'f gI/ Permit Use:
Owner: .4 /t-ort-c 9 $ 4 a P I/ Phone (Daytime Contact):
Mailing Address: f‘e ice_--p C. �� zip/cue
Contractor: .57(,//'-e-/ License#: Srd - / -/ one#: j/iV Ft4.,,V
Mailing Address: `'/(' ' /'' ,be)hii- gCity 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(WSEC min.AFUE X $50.00 =
5 rating) Equal to or less than 400,000
USED APPLIANCE(WSEC min.AFUE X $100.00 =
6 rating) More than 400,000 _
7 BOILER/REFRIGERATION 1-100M BTU X $15.00 =
8 BOILER/REFRIGERATION 101-500M BTU .X $28.00 =
9 BOILER/REFRIGERATION 501-1,000M BTUX _ $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 FIREPLACEX , $10.00 =
13 RANGE X $10.00 =
14 DRYER X $10.00 =
15 FUEL BURNING WATER HEATER X $10.00 =
16 MISC.FUEL BURNING APPLIANCEX $10.00 ,_
17 GAS PIPING(each outlet) X $1.00 =
18 DUCT SYS.EMSr X $10.00 =
19 VENTILATING FANSX $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 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 = t 2
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 TANKX $10.00 =
31 WOOD OR PELLET STOVE/INSERTX $10.00 , =
32 WOOD STOVE-FREE STANDING X $25.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK 0 VISA Q MC DATE: PROCESSING FEE $35.00
Q9
CARD#: EXPIRES: TOTAL PERMIT FEE DUE: ✓
AUTHORIZED SIGNATURE: