1991, 05-03 Permit App: 91001958 Gas Log, PipingFax ,d S' -/P -f(
MECHANICAL P 11't APPLICATION FORM Q
Informatipon Worksheet 9�- /Q55
JOB STREET ADDRESS: S. 27/000/ f� i c�� U��,✓ 7h
CITY/STATE/ZIP: Jpo/(2 h,c_., '%j/} . 7ga0(o PARCEL NUMBER:
OWNER: V e.. L o nj ) L; Acta
MAILING ADDRESS:
PHONE NUMBER: 9.2Y- 33a
(Street)
(City/State) (Zip)
CONTRACTOR: Aire Valley Heating & Cooling LICENSE NUMBER: AIREVHI1410H
MAILING ADDRESS: N. 521 Ella Rd.
PHONE NUMBER: 924-0018
(Street)
Spokane, WA
99216
(City/State)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100;000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIF;ING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 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)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU_
UNLISTED 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
X$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 4.00 =
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 =
10 "
NOTE: MINIMUM PERMIT FEE IS $35.00
e & ?47
Spo ane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE
$ i fi %
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=
SIGNATURE