1991, 10-01 Permit App: 91006370 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 02 / S S • cMM40�)a-VI %i- 637&
CITY/STATE/ZIP: crey49eo ,A+l/,l• PARCEL NUMBER:
OWNER: !o ob /Ale J/$ PHONE NUMBER: 902 2- X53 y
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: AIRE VALLEY LICENSE NUMBER: 4/IREUNI /9/o H
HEATING & COOLING, INCPHONE NUMBER:
N. 521 ELLA RD.
MAILING ADDRESS: SPOKANE, WA 99212
(Street) - (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
x 25.00
GAS WATER HEATER 1 x 10.00 = /dff-
GAS EQt IPMENT<10a,000'BTU(INCLUDES / x 12.00 = /,2
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
SAS PIPING( A OUTLET . .. �- x 1.00 = 2 °i
BOILER/REFRIG 1-100M BTU x 12.00 =
x
20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOIL Rfi/REFR101,0001. i,750M BTU.... . ;... :::::::`. <;: : x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP&SIR CONDITIONED 0.3 TONS >. `: ; :; x 12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS • x 20.00 =
• HEA' PUM ' I i ONDITIONEI 15 Vit)TONS;; x 25.00 = .
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HST PUMP Alli+CONDITION I a U TONS x 60.00 =
VENTILATING FANS x 10.00 =
x 10.00 =
TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 =
1 0 =
x 00
CLOTHES DRYER x 10.00 =
x 10.00 =
:..;:.. :.:.....:.:.:::.
GAS LOG x 10.00
MISC Lfi AN OUS(NOT COVERED ELSEWHEt E x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
Ut INST D GAS.APPLIANC >400,000.1BTU x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
USEQ APPLIANCE 400,000 BTU x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
AIt HANDLI �10,AQ0 CSM x 15.00 =
SUBTOTAL $ 2 9.00
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ Y9 .00
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675