2004, 12-17 Permit App: 04009444 AC tizi_.9Lyzizi
MECHANICAL PERMIT APPLICATION Community Development Department
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Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
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' For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Ad ress: i• • 4 • • . 4� Permit Use:
Owner: x% fl o- 111;w111.41bGOA
� ,p Phone (Daytime Contact): (IR'-1- I Si
Mailing Address: )4-1 17 4 �� ►� IJ�TCity 9�a t LI
State Zip Code
Contractor:
License#: Phone#:
Mailing Address: crty State Zip code
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
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1 FUEL BURNING APPLIANCE
Equal to or less than 100,000 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(VVSEC 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 =
501-1,000M BTU X $25.00 =
9 BOILER/REFRIGERATION ,
10 BOILER/REFRIGERATION
1,001-1,750M BTU X $35.00 =
11 BOILER/REFRIGERATION
More than 1,750M BTU X $60.00 =
X $10.00 =
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 $1.00 =
17 GAS PIPING(each outlet) ,
X $10.00 =
18 DUCT SYSTEMS
X $10.00 =
19 VENTILATING FANS
=
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 = I St DO
X $10.00 =
22 EVAPORATIVE COOLERS
X $50.00 '=
23 TYPE I HOOD
X $10.00 =
24 TYPE II HOOD
25 HEAT PUMP/AIR CONDITIONER
0-3 TON X $12.0
0 =
26 AIR CONDITIONER
3-15 TON X $20.00 =
27 AIR CONDITIONER
15-30 TON X $25.00 =
26 AIR CONDITIONER
30-50 TON X $35.00 =
29 AIR CONDITIONER
More than 50 TON X $60.00 =
X $10.00 =
30 LPG STORAGE TANK
X $10.00 _ =
31 WOOD OR PELLET STOVE/INSERT
X $25.00 =
32 WOOD STOVE-FREE STANDING
X $15.00 =
33 REPAIR&ADDITIONS
X $12.00 =
34 VENTILATION SYSTEMS
X $12.00 =
35 VENTILATION MECHANICAL EXHAUST
X $19.00 =
36 INCINERATOR-RESIDENCE
X 522.00 =
37 INCINERATOR-COMMERCIAL
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK 0 VISA ❑MC
DATE: PROCESSING FEE $35.00
EXPIRES: TOTAL PERMIT FEE DUE:
CARD#'
AUTHORIZED SIGNATURE: