1992, 06-03 Permit App: 92003952 Gas Log, Piping1a,531_
chaos £' V�
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: -'737a cC a. r
ga-3`15D,,
Cor}(6
CITY/STATE/ZIP: Pnk64�CQ
OWNER: �ivl,r'n / Pe. nYla ,o.r
PARCEL NUMBER:
PHONE NUMBER:
9,2 - 72/7
MAILING ADDRESS:
(Street) (City/State)
CONTRACTOR: AIRE VALLEY HEATING & cooling LICENSE NUMBER: AIREVHI1410H
PHONE NUMBER: 924-0018
MAILING ADDRESS: N. 521 Ella Rd. Spokane, WA 99212
(City/State)
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EetmenitN-r <00,000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILEWREFRIG 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001 1 750M BTU:
BOILER/REFRIG +1,750M BTU
HEAT PUMP &AIR CONDITIONER 0-8<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 HOOD)
:TYPEILNQOD
CLOTHES DRYER
.:..:.:: ......:.. .:::........:.
GAS LOG
MISCELLANEOUS (NOT COVERED El SEI HEP.S
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
(Zip)
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 .--
x
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/°.?--
/
/0 a_
SUBTOTAL
$ //,,
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 3 6 QO
SIGNATURE �� Ji,gvwrd/i
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675