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1992, 03-13 Permit App: 92001515 Mechanical Fixtures63.55 cb3 �� �S licco< MECHANICAL PERMIT APPLICATION FORM -j Information Worksheet JOB STREET ADDRESS: / 7 76 .E. r)il51.(),974 CITY/STATEIZIP: 4'fzfLe7 144- PARCEL NUMBER: OWNER: /elC tZ,fr ci l(. c- M7974 PHONE NUMBER: lfd -0/i/ MAILING ADDRESS: q Dl5 (5 CcASci (Street) (City/State) 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) .................................. WOODSTOVEIINSEtT..... GAS WATER HEATER GAS EQUIPMENT <100,000 BTU (INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) ..................................................................................................................... GAS PIPING (EA OUTLET) BOILER/REFRIG 1-100M BTU ....................................................................................................................... BOILER/REFRIG.101'-500M BTU BOILER/REFRIG 501-1,000M BTU ............................................. BOILER/REFRIG 1x0001 1 750M:BTU. BOILER/REFRIG +1,750M BTU ................................................................................................................... HEAT PUMP;&AIH CONDI:T IONER ........................................................................................................................ HEAT PUMP & AIR CONDITIONER 3-15 TONS 'Next 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) ..................................................................................................................... :TYPE.IIiH CLOTHES DRYER ........................................................................ GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANCE>400000 BTU USED APPLIANCE <400,000 BTU USED:APPLIANCE>400,000 BTU AIR HANDLER <10,000 CFM ................... .. . AIR HANDLERt>10 000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE/44e/ (Zip) (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 =l x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x25.00 = x35.00 = 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 = ( /2. °'D °- •• SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ c3 Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675