2004, 01-08 Permit App: BLD-04-03386 Piping 01/08/2004 10:22 5094841505 RR HEATING PAGE 02
City of
Spokane Valley Mechanical Permit Application Fax#688-0037
Project Permit �^
Address: 11616 E 38th Use: l.J V 3 3
Owner: Agman & Karen Stromgren Phone(daytime contact):
891-622 •
Mailing Address SAME
(street) (city/state) (zip)
Contractor. R&R Heating and AC, Inc. License: RRH , •106BW
Mailing Address 4019 E Central Phone#: 484-140
Spokane, Wa 99217
(street) (city/state) (zip) .
Description of Work #of units Cost = Amount
1 Fuel burning appliance -or< 100,000 X 15.01 = 0.00
2 Fuel burning appliance > 100.000 X 19.00 = 0.00
3 Unlisted appliance(additional charge) -or<400,000 X 50.0• = 0.00
4 Unlisted appliance(additional charge) >400,000 X 100.0• = 0.00
5 Used appliance(WSEC's min.AFUE rating) -or< 100,000 X 580.•• = 0.00
6 Used appliance(WSEC's min.AFUE rating) >400,000 X 100.1# = 0.00
7 Boller/refrigeration 1-100M BTU X 15.01 = 0.00
8 Boller/refrigeration 101-500M BTU X 28.0* = 0.00
9 Boiler/refrigeration , 501-1,000M BTU X 39.0• = 0.00
10 Boiler/refrigeration 1,001-1,750M BTU X 57.•• = 0.00
11 Boller/refrigeration + 1,750M BTU X 95.0• = 0.00
12 Gas log, gas insert, gas fireplace - X 10.01 = 0.00
13 Range - X 10.0.1 = i 0.00
14 Dryer - X 10.01 = 0.00
,
15 Fuel burning water heater - X 10.01 0.00
16 Miscellaneous fuel burning appliance - X 10.01 = 0.00
17 Gas piping. (each outlet) - 3 X 1.01 = 3.00 •
18 Duct systems - X 10,01 = 0.00
19 Ventilating fans - X 10.01 = 0.00
20 Air handler(does not include ducting) -or< 10,000 CFM X 12,0• = 0.00
21 Air handler(does not include ducting) > 10,000 CFM X 19.01 = 0.00
22 Evaporative coolers - X 10.00 = 0.00
23 Type I hood - X 50.01 = 0.00
24 Type II hood - X 10.0• = 0.00
25 Heat pump/air conditioner 0-3 tons X 12.01 = 0.00
26 Air conditioner 3-15 tons X 20.11 = 0.00
27 Air conditioner 15-30 tons X 25.0• = 0.00
28 Air conditioner 30-50 tons X 35.01 0.00
29 Air conditioner +50 tons X 60.01 = 0.00
30 LPG storage tank - X 10.01 = 0.00
31 Wood or pellet stovellnsert - X 10.0.1 = 0.00
32 Wood stove-free standing - _ X 25.01 = 0.00
0 Cash 0 Check 0 Visa 0 MasterCard -ubtotal
3.00
Faxed permits will only be accepted with payment of a major credit card Plus Processing
Fee 35.00
Date: Expires: Total Per it Fee
Due 38.00
Bankcard Number:
Authorized Signature:
JAN 05 2004 09 36 5094841.505 PAGE.02