1992, 06-01 Permit App: 92003858 Mechanical FixturesMECHANICAL -PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: S , 7 c -c,..0.).__ I .
CITY/STATE/ZIP: 5;04/424-e-, 14}PARCEL NUMBER:
OWNER: „tf r // C /.c 11'.a /4n of PHONE NUMBER: !a� - %Y -s"
MAILING ADDRESS:
(Street) (City/State)
CONTRACTOR: AIRE VALLEY HEATING & cooling LICENSE NUMBER: AIREVHII Al nu
924-0018 Polo Ir
(Zip)
PHONE NUMBER:
MAILING ADDRESS: N. 521 Ella Rd. Spokane, WA
(Street)
99212
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
X EACH
UNIT
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
........................................................................................................................
VQ00,0 .V
..........
OOI�STO _Eli.NS.
GAS WATER HEATER
GAS QUIPMl NT <100,000 BTU (INCLUD S
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
;BOILEF /:REFRIG.1t11:
......................................................................................................................
........................................................................................................................
BOILER/REFRIG 501-1,000M BTU
.........................................................................
BOILER/IEFIIG 1,0001 1,750M BTU
BOILER/REFRIG +1,750M BTU
..........................................................................
'HEAT.P:U.MP &:AIR CONDITION
....................................................................................................................
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP.& AIR CONDIT:IONER:15 $()<70S
HEAT PUMP & AIR CONDITIONER 30-50 TONS
..........................................................................
HEAT PUMP.&:AIR C7NDITIONE:1:+.50:TONS .:
VENTILATING FANS
::............. ..................................... .
.......................................................................................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
..........................................................................
CLOTHES DRYER
..........................................................................
....................................................................................................................
GAS LOG
MISCELLANEOUS (NOT COVERED ELS,EWHE:
UNLISTED GAS APPLIANCE <400,000 BTU
................... .
ULINSTED GAS APPLIANCE>400 000 BTU
USED APPLIANCE <400,000 BTU
. .......................................................................................................
USED APPLIANCE X00,000 BTU ;; ....:, : .
AIR HANDLER <10,000 CFM
1; :_b R 1:0►.00:0 CFM::::::;:::::
NUMBER
OF UNITS
/
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
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 =
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 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
rS T#
cesu my
/2
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
1� a 44/
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
$ J. ?.'8
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ ,3 3,60