2006, 01-25 Permit App 06000169 Mechanical FixturesS kikane
�.s Val ley
Community Development
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokanevalley.ortt.com
Mechanical Permit Application
-*se
o Commerk,
SITE ADDRESS Al. S3O FL o A A
SPopEtJ&
,ERIVITINUIVD3E_
Residential
VAt. :dA.
Building owner
Name: JLLe-A) fQAI0 L
Phone:
370- I/7$T Fax
Address: / 9 '3 .,2 3 rr P o
City Siboka„,,,,_ //441state 14/4 • Zip 9 9D/6
Contractor
Name: ANDFRSOA! 7S He:17-/A1G -
Phone:
9',2g-0 fg 0 Fax: 7C2 2 -3//g
Address: E., / 3 90 3 '»t err -I-
City Spoka,.1 Ve/jey State [J4 • Zip
9 ?VA
License No: 4,D/Ueksiyi / C NZ
City Business License No:
•
Contact CM/6 A / i &-Ks-o
70i:0 �i.d
Name:
-1 ------------
Phone:
# OF UNITS
X
1
2
3
4
5
6
7
FUEL BURNING APPLIANCE
FUEL BURNING APPLIANCE
UNLISTED APPLIANCE (Additional Fee)
UNLISTED APPLIANCE (Additional Fee)
USED APPLIANCE (WSEC min. AFUE rating)
USED APPLIANCE (WSEC min. AFUE rating)
BOILER/REFRIGERATION
Equal to or less than 100,000
More than 100,000
Equal to or less than 400,000
More than 400,000
Equal to or less than 400,000
More than 400,000
1 - 100M BTU
l
x
X
X
COST = TOTAL AMOUNT
$12.00
$15.00
$50.00
$100.00
$50.00
$100.00
8
9
BOILER/REFRIGERATION
BOILER/REFRIGERATION
101 - 500M BTU
501 - 1,000M BTU
X
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
11
12
13
BOILER/REFRIGERATION
GAS LOG, GAS INSERT, GAS FIREPLACE
RANGE
More than 1,750M BTU
X
14
15
16
17
18
DRYER
FUEL BURNING WATER HEATER
MISC. FUEL BURNING APPLIANCE
GAS PIPING (each outlet)
DUCT SYSTEMS
/
X
X
X
X
X
19
20
21
22
23
VENTILATING FANS
AIR HANDLER (DOES NOT include ducting)
AIR HANDLER (DOES NOT include ducting)
EVAPORATIVE COOLERS
TYPE I HOOD
Equal to or Tess than 10,000 CFM
Greater than 10,000 CFM
X
X
24
TYPE II HOOD
25
26
27
28
HEAT PUMP/AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
0-3 TON
3-15 TON
15-30 TON
30-50 TON
X
X
X
29
AIR CONDITIONER
More than 50 TON
30
31
32
33
34
LPG STORAGE TANK
WOOD OR PELLET STOVE/INSERT
WOOD STOVE - FREE STANDING
REPAIR & ADDITIONS
VENTILATION SYSTEMS
X
X
35
36
37
VENTILATION MECHANICAL EXHAUST
INCINERATOR - RESIDENCE
INCINERATOR - COMMERCIAL
METHOD OF PAAYYMENT:
❑CASH t&CHECK ❑ VISA ❑ MC
CARD #:
AUTHORIZED SIGNATURE:
DATE:
EXPIRES:
SUBTOTAL
$12.00
$20.00
$25.00
$35.00
$60.00
$10.00
$10.00
$10.00
$10.00
$10.00
$1.00
$10.00
$10.00
$12.00
$15.00
$10.00
$50.00
$10.00
$12.00
$20.00
$25.00
$35.00
$60.00
$10.00
$10.00
$25.00
$15.00
$12.00
$12.00
$19.00
$22.00
PROCESSING FEE
TOTAL PERMIT FEE DUE:
_ /2s cv
ry
/3.vo
I1(i$35.00
. , op
REVISED 8/26/05