2009, 03-05 Permit App 09000531 Fuel Brng Appl Permit Center 1 I
�,�; 11703 E Sprague Ave,Suite B-3
PERMIT NUMBER: � 5� ‘
`�' Spokane Valley,WA 99206 �
Vdl (509)688-0036 FAX:(509)688-0037 (
Community Development
www.spokanevalley.org PERMIT FEE: c -
Mechanical Permit Application n Commercial 21 Residential
SITE ADDRESS: 2.,0 y U . Eve r9 r t✓e,}1
Building Owner
Name: s{-eQhxrfe -t- Ghri c Nle :ie,h Phone: �22_v;gqy Fax: . -
Address: n City: c��Oh� State: W^ ZIp: 99Z1 b
�o� N- Every ^e,�n tS
Contractor ��((��
Name: E ccici t'.V1 C,t./ Plus l us Phone: 9,,L(0_ Li 000 Fax: 5.3 z-a 006
Address: ILI 2I I E. .15 F"ncaw City: `�]���y Koontz- State: w Zip: 9 9z(
License No: E FF EC P H 99 1 3-7J City Business Lic:
Contact Name: J t'p.p. 6_0C.>4 rrt r1 h, Phone: q L6,--L!00 b
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 I X $12.00 = 13. OD
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 =
26 AIR CONDITIONER 4-15 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
❑CASH ElCHECK ElVISA ❑MC EXPIRES: PROCESSING FEE $300
CARD#: VIN: TOTAL PERMIT FEE DUE: _0-0 0
AUTHORIZED SIGNATURE:
REVISED 8/26/05