2004, 03-26 Permit App BLD-04-03921 Relocate StoveSpokane
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Project Address:
Owner: 't iNc
Mailing Address:
Contractor:
Mailing Address:
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MECHANICAL PERMIT APPLICATION
City of Spokane Valley Community Development Department
8uildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact): 9W'j -9:S 8
City State
License*: Phone*:
Zip Code
DESCRIPTION OF WORK
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
BOILER/REFRIGERATION
BOILER/REFRIGERATION
BOILER/REFRIGERATION
BOILER/REFRIGERATION
GAS LOG, GAS INSERT, GAS FIREPLACE
RANGE
DRYER
FUEL BURNING WATER HEATER
MISC. FUEL BURNING APPLIANCE
GAS PIPING (each outlet)
DUCT SYSTEMS
VENTILATING FANS
AIR HANDLER (DOES NOT include ducting)
AIR HANDLER (DOES NOT include ducting)
EVAPORATIVE COOLERS
TYPE IHOOD
TYPE II HOOD
HEAT PUMP/AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
LPG STORAGE TANK
WOOD OR PELLET STOVE/INSERT
WOOD STOVE - FREE STANDING
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA ❑ MC
CARD #:
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
101 - 500M BTU
501 - 1,000M BTU
1,001 - 1,750M BTU
More than 1,750M BTU
Equal to or less than 10,000 CFM
DATE:
Greater than 10,000 CFM
0-3 TON
3-15 TON
15-30 TON
30-50 TON
More than 50 TON
EXPIRES:
City
# OF
UNITS
1
X
X
X
X
X
X
X
X
X
SUBTOTAL
COST
$15.00
$19.00
$50.00
$100.00
$50.00
$100.00
$15.00
$28.00
$39.00
$57.00
$95.00
$10.00
$10.00
$10.00
$10.00
$10.00
$1.00
$10.00
$10.00
$12.00
$19.00
$10.00
$50.00
$10.00
$12.00
$20.00
$25.00
$35.00
$60.00
$10.00
$10.00
$25.00
State Zip Code
TOTAL
AMOUNT
PROCESSING FEE
TOTAL PERMIT FEE DUE:
$35.00
AUTHORIZED SIGNATURE: