2004, 02-04 Permit App: BLD-04-03501 Mechanical Fixtures0uI �11a
,,;oOValley
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WAN9206 509-688-0037 - Fax
Mechanical Permit Application
PROJECT /
ADDRESS: 3 & I
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PERMIT
USE:
COST EQUALS
OWNERPHONE
1 FUEL BURNING APPLIANCE
(Daytime Co.ntact):
X
MAILING ADDRESS:
2 FUEL BURNING APPLIANCE
(street)
(city/state) (ZIP)
2
CONTRACTOR: r
3 UNLISTED APPLIANCE (ADDITIONAL FEE)
LICENSE 0:Ide
X
MAILING ADDRESS:
PHONE 0:
F�
—a
FIR
(street)
(city/state) (ZIP)
$100
METHOD OF PAY
CASH
DATE-
DESCRIPr1ON OF WORK
3 OF UNITS
X
COST EQUALS
AMOUNT
1 FUEL BURNING APPLIANCE
- OR <100,000
X
$15
2 FUEL BURNING APPLIANCE
> 100,000
X
519
3 UNLISTED APPLIANCE (ADDITIONAL FEE)
• OR c 40Q000
X
$50 -
4 UNLISTED APPLIANCE (ADDITIONAL FEE)
> 400,000
X
$100
5 USED APPLIANCE (WSEC min. AFUE rating)
- or < 400,000
X
550
ti USED APPLIANCE (WSEC min. AFUE rating)
> 400000
X
$100
7 BOILERIREFRIGERATION
I - loom BTU
X
315
8 BOILERMEFRIGERAT:ON
101 - 500M BTU
X
$28
9 BOILEWREFRIGEAATION
501 -1,000M BTL`
X
$39
10 SOILER/REFRIGERATION
1001 - 1,750M BTU
X
$57 -
11 BOILER/REPRIGERAIION
+1750M BTU
X
$95
12 GAS LOG, GAS INSERT, GAS FIREPLACfi
-
X
$10
13 RANGE
X
$10
14 DRYER
-
X
$10
15 FUEL BURNING WATER HEATER
-
X
$10
71
16 MIST FUEL BURNING APPL
-
X
$10
17 GAS PIPING (w Outlet)
-
X
$I
18 DUCT SYSTEMS
X
$10
19 VENTILATING FANS
-
X
$10
20 AIR HANDLER (DOES NOT include duciin
• OR < 10,000CFM
X
512
2I AIR HANDLER (DOES NOT tndude ducting)
> 10,000 CFM
X
$19
22 EVAPORATIVE COOLERS
-
X
$10
23 TYPE I HOOD
-
X
350
24 TYPE II HOOD
-
X
510
25 HEAT PUMP/AIR CONDITIONER
0.3 TON
X
$12
26 AIR CONDITIONER
3-15 TON
X
no
27 ATR CONDITIONER
15-30 TON
X
S25
28 AIR CONDITIONER
3LM0 TON
X
S35
29 AIR CONDITIONER
•50 TON
X
$60
30 LPG STORAGE TANK
X
$10
31 WOOD OR PELLET STOVEI-INSERT
-
X
310
32 WOOL STOVE - FREE STANDING
-
X
525
MENIT
.-, r,
SUBTOTAL:
PLUS PROCESSING FEE:
TOTAL. PERMIT FEE DUE:
I� , 06/
$35.00
�1G
�,CI IECK
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
LJ �� u •._ .. _
EXPIRES: