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2004, 08-25 Permit App: BLD-04-07460 Mechanical FixturesT0'30dd GOSTVBP60S City of Spokane Valley 6S : E 6 17OWC b l, U10 Mechanical Permit Application Fax # 688-0037 Project Permit Address: 13005 E 28th Use. Owner. Rubin Streifel Phone (daytime contact): 924-8781 Mailing Address SAME street (city/state) zi ) Contractor: R&R Heating and AC, Inc, License: RRHEAA10OBW Mailing Address 4019 E Central Phone#: 4841405 Spokane, Wa 99217 (street) (city/state) zip Description of Work # of units Cost = Amount 1 Fuel burning appliance - or < 100.000 X 15.00 0.00 2 Fuel burning appliance > 100,000 X 1 19.00 0.00 3 Unlisted appliance additional chs a - or < 400,000 X 50.00 = 0.00 4 Unlisted appiianoe additional charge) > 400,000 X 100.00 - 0.00 5 Used appliance EC's min, AFUE rating) - or < 100.000 X 580.00 = 0.00 6 Used appliance (WSEC's min. AFUE rating) > 400,000 X 100.00 = 0.00 7 Boller/refrigeration 1-100M BTU X 15.00 = 0.00 8 Boiler/Wri eration 101-500M BTU X 28.00 0.00 9 Boiler/re frf aretlon 501-1,000M BTU X 39.00 0.00 10 Bo ile r/refrigeration 1,001-1,750M BTU X 57.00 0.00 11 Boiler/refrigeration + 1,750M BTU X 95.00 0.00 12 Gas log,gas insert, gas f re lece - X 10.00 a 0.00 13 Range X 10.00 0.00 14 Dryer - X 10.00 = 0.00 15 Fuel burning water heater X 10.00 = 0.00 16 Miscellaneous fuel burning appliance - X 10.00 0.00 17 Gas piping. (each outlet) - X 1.00 = 0.00 18 Ducts stems - X 10.00 = 0.00 19 Vant,11ating fans X 10.00 = 0.00 20 Air handler does not include ducting) or < 10,000 CFM X 12.00 = 000 21 Air handler does not include ducting > 10,000 CFM X 19.00 = 0.00 22 Evaporative coolers - X 1000 a 0.00 23 Type I hood - X 50.00 0.00 24 Type It hood X 10.00 = 0.00 25 Heat pumptair conditioner 0-3 tons 1 X 12,00 = 1200. 26 Air conditioner 3-15 tons X 20,00 = 0.00 27 Air conditioner 15-30 tons X 25.00 = 0.00 28 Air conditioner 30-50 tons X 35.00 = 0.00 29 Air conditioner + 50 tons X 60.00 = 0.00 30 LPG storage tank X 10.00 m 0.00 31 Wood or pellet stove/insert - X 10.00 a 0.00 32 Wood stove - free standinil X 25.00 0.00 ❑ Cash ❑ Check ❑ Visa ❑ MasterCard Subtotal 12.00 Faked permits will only be accepted with payment of a major credit card Plus Processing Fee 35.00 Date: Expires: Total Permit Fee Due 47.00 Bankcard Number: Authorized Signature: T9/Z0 39dd 9NIiV3H dd SB9Tb8b699 bb :ET V90Z/8T/80