1991, 12-13 Permit App: 91008626 Mechanical FixturesMECHANICAL PERMIT AFeLICATION FORM 1 )II"-
Information
I "Information Worksheet
JOB STREET ADDRESS: y//7 - ) ' s M , 7` � L/a, %a
CITY/STATE//ZIP: c sok Wf , PARCEL NUMBER:
OWNER: /Coq e } 41(m w 4.cs PHONE NUMBER: 20255/- /9 y..3
MAILING ADDRESS:
(Street)
(City/State) (Zip)
CONTRACTOR: AIRE VALLEY HEATING & cooling LICENSE NUMBER: AIREVHI1410H
PHONE NUMBER: 924-0018
MAILING ADDRESS: N. 521 Ella Rd. Spokane, WA 99212
DESCRIPTION
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU 0004g.pg%y.
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING(EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101.'SOOM BTU,
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001 1,750M BTU::
BOILER/REFRIG +1,750M BTU
HEAT PUMP:.& AIR CONDITIONER 0 3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP: & AIR CONDITIONER 15 30;TONS ;',
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP: & AIR CONDITIONER +50,TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF
TYPEI(H000 .'
CLOTHES DRYER
..............................
..............................
giF
RANGE
GAS LOG
MISCELLANEOUS.(NOTCOVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE•>400,000 BTU
USED APPLIANCE <400,000 BTU
:USED APPLIANCE>400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00=
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x60.00= ..c.„
/
/o°2-
/
/,2 ?-2--
3
3,
x 12.00 =
x 20.00 =U
x25.00= en
x 35.00/ki,
x 60.00 ='ke
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x10.00=
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
{:`,_
‘'tt' e
't'.
' (9 7,' - 0
., 'SS'j
- 4:4 4..,
V%).
/per
SUBTOTAL
$ 35.00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 6&OD
.D . /Sacan
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675