1993, 05-20 Permit App: 93003813 AC ii.
ii 4� , 1
+i ,' � MECHANICAL PERMIT APPLICATION FORM
j Information Worksheet i ( i,k
O 5 �l �, //,%/- `�
i •
JOB STREET ADDRESS: �� r�� ��`"
1• CITY/STATE/ZIP: e,.Z lt/:(2/ P CEL NUMBER:
-' OWNER:
'i /q/../: < .t.;P a 6_, PHONE NUMBER: 9S;?- OrcP/_
I ' MAILING ADDRESS: Nc_S�_,✓y E
(Street) (City/State) (Zip)
CONTRACTOR: AIRE VALLEY HEATING & Cooling LICENSE NUMBER: ATREVHT141 OH
PHONE NUMBER: 924-0018
MAILING ADDRESS: N. 521 Ella Rd. Spokane, WA 99212
(Street) - (City/State) (Zip)
I MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
I, DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
:.: :....... .
x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT< 00,000`BTU(INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
.,,.: ............... x 1.00 =
! GAS PIPING(EA OUTLET).....:. ... : ;:;:<»»«:«::.
1 .. . . .. ..... ..... . .;:;
BOILER/REFRIG 1-100M BTU x 12.00 =
i1.00.0 f 11 EEF l.§ 0).M I TU ......... '::: <:>;':::: x 20.00
!il BOILER/REFRIG 501-1,000M BTU
x 25.00 =
•a >B L R�0G9::..Og1 i�� 0:M.:::..t. :..0................,.....'....<.:....>.....
x
35.00
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP' Allo. dNDITItiNEH 0 -3TONS:.. i>> s <>Mi":1 / x 12.00 = / . 0 0
� HEAT PUMP &AIR CONDITIONER 3-15 TONS • x 20.00 =
.HEATPUMP.&AIR CO ]DITIONER 15-30 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP&*10trGNDITIONEF3+50'rQNS .;.. ..... ..
x 60.00 =
3 VENTILATING FANS x 10.00 =
0
x 10.00 =
a TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 =
x
10.00 =
CLOTHES DRYER x 10.00 =
x10
10.00 =
GAS LOG x 10.00 =
MISCELfi ANEOU${NOT COVERED•ELSEWHERE • x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
• i0UNSTED GAS APPLIANCE 5400,000 BTU x100.00 =
•USED APPLIANCE<400,000 BTU x 50.00 =
t :USED APPUAN.CE>d00,0o0 BTU : ;:...... x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
i
� AIt�I�ANp��R§iO QO4.+CFM �'
....... ' <<°< < x 15.00....:
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
! '
; i FEE DUE =$ 3769
SIGNATURE 6;
'r_,.-/p_,e
, , :
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675