1991, 07-29 Permit App: 91004578 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM �` ! C
Inf-rmation Worksheet A(' L
JOB STREET ADDRESS: / 7 / S' S'_ X Cc A t1.e- Yi Pd i `
CITY /STATE/ZIP `'=' - 0-61'-3 <7
OWNER: h
PHONE NUMBER:
MAILING ADDRESS:
CONTRACTOR: Aire
(Street)
Valley Heating & Cooling
MAILING ADDRESS: N. 521 Ella Rd.
(City/State)
LICENSE NUMBER: AIREVHI1410H
PHONE NUMBER: 924 -0018
DESCRIPTION
(Street)
(Zip)
Spokane, WA.
(City /State)
MECHANICAL WORKSHEET /FEE SCHEDULE
ELECTRIC /DUCTWORK
:WO STOVL/INSl p,''
GAS WATER HEATER -
GAS E IUIPMENT't1:.:.. .. ,,...,..,
GAS EQUIPMENT +100,000 BTU DUCTWORK)
,GAS: PIPING (EA OUT�ETa .... ..::....: :............... -._..:
BOILER. /RERIG 1 -100M BTU
fI EPt IG X01 --500M BTU > ,. ...
BOILER/REFRIG 501- 1,000M BTU
IIIMENREF 1IG .000 1,75oM.BTU
BOILER/REFRIG +1,750M BTU
A > fMP & AIR CONDITIONER 0 ;3
HEAT PUMP & AIR CONDITIONER 3 -15 TONS
HEAT;F: Mp 1R CONDITIONER 15 30 TON
HEAT PUMP & AIR CONDITIONER 30 -50 TONS
....................
HEAT PUMP & AIR CONDITIONER 50 TC
VENTILATING FANS
EVAPORATIVE= COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
'IN ST 1. >GAS
USED APPUANCE <400,000 BTU
r : i#;:AP r �ilr\i? .: VVtlT471i -P. Wi a iz<e y�t
AIR HANDLER <10,000 CFM
NOTE MINIMUM PERMIT FEE IS $35.00
SIGNATURE ✓1 �� �O. a.�ililfl
99212
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 .=
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 10.00 =
x10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x10.00 =
x 50.00 =
x100.00 =
x 50.00 =
X100.00 =
x 12.00 =
x 15.00 =
/
/ 0
/
/o2 %.-
/
i
/a -0
'
SUBTOTAL
$ 3,,c- 0b
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 6 0.0o
Spokane County Division of Buildings
VVest 1303 Broadway Avenue Spokane, WA 99260 (509) 456 -3675