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1993, 05-24 Permit App: 93003882 ACMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: / ' ��1/�G G /7e/, _47 / ,J CITY/STATE/ZIP: o /e�77/J, PARCEL NUMBER: `151L4 •�%I�C( OWNER: 7~ 0 /97 ��/��� PHONE NUMBER: 9, C� >' 725 /L) O0 740 MAILING ADDRESS: ...S/0//1--- 7 (Street) CONTRACTOR:AIRE VALLEY HEATING MAILING ADDRESS: 521 N FLT.A ROAD (Street) DESCRIPTION (City/State) (Zip) LICENSE NUMBER: AIREVHI 1 41 OH PHONE NUMBER: SPnxAN.E, WA (City/State) MECHANICAL WORK ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVI /INSER• I<' GAS WATER HEATER +GAS EQUIPMENT <100,000 BTU (INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING (EA OUT •ET) BOILER/REFRIG 1-100M BTU ....................... . BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,0001 1 T`50M Bi u BOILER/REFRIG +1,750M BTU HEAT' PUMP. AI CONDITIONED 0--3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS • itIOATP.OMOCARpoNompoER' 15 30 T• ONS HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT..PUMP &.AIR CONDITIONER +50.TONS:... VENTILATING FANS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG MISCELLANEOUS (NOT COVERED !ELSEWHFF 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 = x25.00 = x35.00 = x 60.00 = x12.00 = 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 = x10.00 = / /1.O2 . - • • x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ 42 Orli PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ 3'7:a) if Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675