1991, 05-28 Permit App: 91002894 Water Heater, PipingMECHANICA::�.PERMIT APPLICATION FORM
• Information Worksheet
JOB STREET ADDRESS: f . 700 3 / trt 1/ II_t✓
CITY/STATE/ZIP: Spo/Can. b-14- . 990210Z PARCEL NUMBER:
OWNER: L S /P.o cud PHONE NUMBER:
MAILING ADDRESS:
$. (Street) (City/State) (Zip)
CONTRACTOR. Aire Valley Heating & Cooling LICENSE NUMBER: AIREVHI1410H
PHONE NUMBER:
MAILING ADDRESS: N. 521 Ella Rd. Spokane, WA.
99212
(Street) . (City/State)
MECHANICAL WORK
DESCRIPTION .`
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
n •-
•
:GAS WATER HEATER
C 4.0:0. M WT<iQ0, 4.013TU(INCLi1PES>:`a;
GAS EQUIPMENT +100,000 BTU DUCTWORK)
/.. GAS PIPING EA OUTLE .::.r .... .::
•
¢:=gt BOILER/REFRIG 1-100M BTU
BQ f; nertiIG 10 50orom i -t
BOILER/REFRIG 501-1,000M BTU,.;..}:;:;..
9010ER/REr Al i 0001=.:1,75oM Bt(iff n "_...-
., BOILER/REFRIG +1,750M BTU .
EAT,PUMP'& AIR:CONDITIONER'0-3'TONS€' -t: Y .; "£
HEAT PUMP & AIR CONDITIONER 3-15 TONS
j- T5;PUMP;&_'AIRCONQITIONER 5=30_TONS:;:_:::,,
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMPAAIR CONDITIONER+SQ TONS • }
VENTILATING FANS
EVAPORATIVE,COOLERS',.::::.;:;:' :
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE:II_HOOD:-'a
CLOTHES DRYER
'RANGE".`.:
GAS LOG
AIS Li ktgOO (NOTtO EREO t. SEWN
UNLISTED GAS APPLIANCE <400,000 BTU b •
USED APPLIANCE <400,000 BTU :
tUSE SE�,, Of1;000m:11:
AIR HANDLER <10,000 CFM •
rfiftWOMEOPPic
NOTE: MINIMUM PERMIT FEE IS $35.00
I ' SIGNATURE i ICd
- • dam"
(ZIP)
NUMBER -
OF UNITS
X EACH
UNIT '
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x 12.00 = '
x 15.00 =
x1.00=
x 12.00 =
x20.00='
x 25.00 =-?
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x10.00 =
x 50.00 =
x100.00 =
x50.00=
x100.00 =
x 12.00 =
x15.00 =
f
/0 t -:-'-
/
/
7
..
SUBTOTAL
$ // °,'
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ X34, ��
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675