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1993, 05-27 Permit App: 93004030 AC
s ( Cps-F.n' Q MECHANICAL PERMIT APPLICATION FORM L .-(P Lb -4 Information Worksheet JOB STREET ADDRESS: S / / 7 77// UIQ CITY/STATE/ZIP:.,S'Ol904i/Z//= PARCEL NUMBER: OWNER: (eo 2 i? r /-----/e0/276- PHONE NUMBER: MAILING ADDRESS: 'df/%2%/ (10-30 (Street) CONTRACTOR: AIRE VALLEY HEATING MAILING ADDRESS: (City/State) (Zip) LICENSE NUMBERLiIREVHI 1 41 nH PHONE NUMBER: DESCRIPTION A., 1, (Street) (City/State) MECHANICAL WORK ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOi�DSTiJV�/ NSERT.. ,. GAS WATER HEATER GAS EQUIPMNT 100,000:BTU(INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) GASPIPING (EA bUT B BOILER/REFRIG 1-1uOM BTU EF... :..th.. M B.., BOILER/REFRIG 501-1,000M BTU BOiLER/RI FRIG 1.0001 1, 5DM 0TU; BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONER 0- TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP AIR CONDITIONEp'15 S0 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS AtAt PUMP & AIR CONbITIONER14- S.TONs ............................:....:......................... VENTILATING FANS EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG MISCELLANEOUS;(NOT COVERED ELSEWHERE;: UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED +GAS APPLIANCE 5400,000 BTU USED APPLIANCE <400,000 BTU USED APPLIANCE X400,000 BTU AIR HANDLER <10,000 CFM ALR HANDLER:*10,000 CPM . NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE ,.e7-',4//' (Zip) NUMBER OF UNITS X EACH UNIT - AMOUNT x 10.00 = x25.00 = x 10.00 = x12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 = x25.00 = x 35.00 = x 60.00 = x12.00= x20.00= x 25.00 = x35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = X 10.00 = x10.00 = x 10.00 =• x 10.00 = / /.,1 00 , • • x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ /";7- . 6 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ 7a'j Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675