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2004, 07-15 Permit App BLD-05-07071 AC
SpayQ1'F O • n ley MECi tAMOAL PERMIT APPL PROJECT ADDRESS:, v'¢ [ d �. i �t,. ;" USRM'T USE :ft�., a �+j„r 4, , OWNER: t R' ,... PHONE (Daytime Contact) - - , 2� � MAILING ADDRESS. (strt eet) (city/state) (zip) CONTRACTOR: r( 13 c1- G }441 cut& Ale LICENSE #: f c14.6kris} et;r�t3 — 13cl/figifsenorl,ci� PHONE#: Cl MAILING ADDRESS: CLeG2E. Cc,-Ett1Glo SPoKa(i Wa-- •i1g2(6 (street) (city/state) (zip) DESCRIPTION OF WORK 1 FUEL BURNING APPUANCE 2 FUEL BURNING APPLIANCE 3 UNLISTED APPLIANCE (ADDITIONAL FEE) 4 UNLISTED APPLIANCE (ADDITIONAL FEE) 5 USED APPLIANCE(WSEC min. AFUE rating) 6 USED APPLIANCE(WSEC min. AFUE rating) 7 SOILER/REFRIGERAT!ON B BOILER/REFRIGERATION 9 BO!LER/REFRIGERATION 10 11 BOILER/REFRIGERATION B OILER/REFRIGERATION = OR<100,000 >100,000 =0R<400,000 >400,000 =OR<400,000 >400,003 1-100M BTU 101.50CM BTU 501-1,000M BTU 1001-1,750M BTU +1750M BTU # OF WW1 x x X x x x x n x COST $15 $19 $50 $100 $50 $1 00 12 GAS LOG, GAS INSERT, GAS FIREPLACE 13 14 15 16 17 18 RANGE DRYER x X $15 $28 $39 $57 595 $10 $10 EQUALS AMOUNT Y FUEL BURNING WATER HEATER MISCELLANEOUS FUEL BURNING APPL GAS PIPING (ea. Outlet) DUCT SYSTEMS x $10 x $10 19 20 21 22 23 24 25 26 27 28 29 30 31 32 VENTILATING FANS AIR HANDLER (DOES NOT include ducting) AIR HANDLER (DOES NOT include ducting) EVAPORATIVE COOLERS TYPE IHOOD TYPE II HOOD =OR<10,0000FM >10,000CFM x x x x x x x X $10 $1 $10 $10 $12 519 $10 $50 HEAT PUMP/AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER LPG STORAGE TANK 0-3 TON 3-15 TON 15-30 TON 30-50 TON +50TON x x x x x x 510 $12 $20 $25 $35 $50 _ /,a' -tip WOOD OR PELLET STOVE/INSERT WOOD STOVE -FREE STANDING X $10 X $10 x $25 ❑CASH ❑CHECK ❑.= ❑ FA7©?ERMISS WILE, OILY 3E ACCEPTED wax PAYE3NT OF AN.AJOR CRODR'(*iv DATE,: EXPIRES: BANXCAZD NUMBER.: AUTHORIZED SIGNATURE: SUBTOTAL PLUS PROCESSING FEE $35.00 TOTAL PERMIT FEE DUE