2003, 08-21 Permit App: BLD-03-02300 Piping ((��OTY( 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
1J � ne Spokane Valley,WA, 99206 509-688-0037-Fax
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Mechanical Permit Application
PROJECT PERMIT
ADDRESS: a 0 -3, ,
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OWNER r rJ. 1 ( d++ PHONE(Daytime Contact): I
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: F I` n C 4 //_L 5/Cj_M�LICENSE#: �n q C I K A
MAILING ADDRESS T6 T 7Z PHONE#: '17o
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(street) (city/state) (ZIP)
DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE -OR<100,000 X $15 -
2 FUEL BURNING APPLIANCE >100,000 X $19 -
3 UNLISTED APPLIANCE(ADDMONAL FEE) -OR<400,000 X $50 =
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 -
5 USED APPLIANCE(WSEC min.AFUE rating) -or<400,000 X $50 -
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 =
7 BOILER/REFRIGERATION 1-100M BTU X $15 -
8 BOILER/REFRIGERATION 101-500M BTU X $28 -
9 BOILER/REFRIGERATION 501-1,000M BTU X $39 -
10 BOILER/REFRIGERATION 1001-1,750M BTU X $57 -
11 BOILER/REFRIGERATION +1750M BTU X $95 -
12 GAS LOG,GAS INSERT,GAS FIREPLACE - X $10 -
13 RANGE - X $10 -
14 DRYER - X $10 =
15 FUEL BURNING WATER HEATER - X $10 -
16 MISC FUEL BURNING APPL. - X $10 =
17 GAS PIPING(ea.Outlet) - t-,. x $1 -
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - X $10 -
20 AIR HANDLER(DOES NOT include ducting) -OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM X $19 =
22 EVAPORATIVE COOLERS - X $10 -
23 TYPE I HOOD - X $50 -
24 TYPE II HOOD - X $10 -
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 -
26 AIR CONDITIONER 3.15 TON X $20 -
27 AIR CONDITIONER 15-30 TON X $25 -
28 AIR CONDITIONER 30-50 TON X $35 -
29 AIR CONDITIONER +50 TON X $60 =
30 LPG STORAGE TANK - X $10 -
31 WOOD OR PELLET STOVE/INSERT - X $10 -
32 WOOD STOVE-FREE STANDING - X $25 -
SUBTOTAL:
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
4 f i TOTAL PERMIT FEE DUE:
0 CASH "CHECK ❑ iniSia ❑ '
DATE: - ` - U 3
'D EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE: