2004, 09-30 Permit App: BLD-04-07810 Wood Stove MECHANICAL PERMIT APPLICATION
, Sarr City of Spokane Valley Community Development Department
I,',Slne BuildingDivision
ley
11707 E. Sprague Avenue, Suite /06
40000Val - Spokane Valley, WA 99206
Phone: (509)688-0036; Fax: (509) 688-0037
(� FOR INSPECTIONS, CALL(509) 688-0054
Project Address: I D-7 I6 E. C 1 V0.01617)4 Permit Use: (-')0 O 0 Sit t/t
Owner: Tg; `11Aor✓�I avi Phone(Daytime Cpntact):
Mailing Address: Sa,1a ) S pt.It Ave (16, I I t c:
4, ito of f City State G, Z,ip Cr,
Contractor: 1l YJt License#: Phone#: / 31 - /�(
Mailing Address:
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK _ UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 X $15.00 =
2 FUEL BURNING APPLIANCE More than 100,000 X $19.00 =
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 -
USED APPLIANCE(WSEC min.AFUE
5 rating) Equal to or less than 400,000 X $50.00 =
USED APPLIANCE(WSEC min.AFUE
6 rating) More than 400,000 X $100.00 =
7 BOILER/REFRIGERATION 1-100M BTU - X $15.00 . =
8 BOILER/REFRIGERATION 101-500M BTU X $28.00 =
9 BOILER/REFRIGERATION 501-1,000M BTU X' $39.00 =
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $57.00 =
11 BOILER/REFRIGERATION More than 1,750M BTU X $95.00 =
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 $10.00 -
17 GAS PIPING(each outlet) X $1.00 =
18 DUCT SYSTEMS X $10,00 =
19 VENTILATING FANS X $10.00 =
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 $19.00 =
22 EVAPORATIVE COOLERS X $10.00 =
23 TYPE I HOOD X i $50.00 =
24 TYPE Il HOOD X $10.00 =
25 HEAT PUMP/AIR CONDITIONER r 0-3 TON X $12.00 =
26 AIR CONDITIONER 3-15 TON X $20.00 =
27 AIR CONDITIONER 15-30 TON X $25.00 =
28 AIR CONDITIONER 30-50 TON X $35.00 =
29 • AIR CONDITIONER More than 50 TON X ' $60.00 =
30 LPG STORAGE TANK • X $10.00 =
' 31 WOOD OR PELLET STOVE/INSERT __X : $10,00 =
32 WOOD STOVE-FREE STANDING X $25.00 = c72-J •O 0
METHOD OF PAYMENT: SUBTOTAL a 5--60
El CASH 0 CHECK ❑VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE: . l:Y'. OU
AUTHORIZED SIGNATURE: