2005, 12-22 Permit App 05004752 Heat Pump Permit Center
Spb`kane 11707E Sprague Ave,Suite 106 PERMIT NUMBER: ���
jValley Spokane Valley,WA 99206 y
(509)688-0036 FAX:(509)688-0037 •
Community Development ww..w.spokanevallev.or...com PERMIT FEE:
Mechanical Permit Application n Commercial
SITE ADDRESS: RResidential
Building owner dP(_7j CA75'7/
Name: • Phone: 5-'`,Z - /x17 Fax:
Address: 7 /O/ C_ [_c.4c;4,,4 City:SPO,At,"a //41;_State: 4V11- Zip:
Contractor Sp()/444),- C4)49.t-a-t A 7,../Tc=w /: iC" -
Name: / Phone: Fax:
Address: /(i Z/ 4) . 6A,C. -4� L,.,Z,/ City: --Ve.t,44,,,.."" State: Gv 1 � Zip: �2/�License No: ,S-P( /<'4c. �/ /4'4 City Business License No:
Contact '
Name:
Phone:
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 / X $12.00 = /2 O 0
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(WSEC 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 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $25.00 =
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $35.00 =
11 BOILER/REFRIGERATION More than 1,750M BTU X $60.00 =
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 $15.00 =
22 EVAPORATIVE COOLERS X $10.00 =
23 TYPE I HOOD X $50.00 =
24 TYPE II HOOD X $10.00 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON / X $12.00 = /2 -CO
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 =
33 REPAIR&ADDITIONS X $15.00 =
34 VENTILATION SYSTEMS X $12.00 =
35 VENTILATION MECHANICAL EXHAUST X $12.00 =
36 INCINERATOR-RESIDENCE X $19.00 =
37 _ INCINERATOR-COMMERCIAL X $22.00 =
METHOD OF PAYMENT: SUBTOTAL 221 CC
['CASH 0 CHECK 0 VISA ElMC DATE: PROCESSING FEE
$35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: 7 aavtssn 8n6/o5