1992, 10-01 Permit App: 92008286 Heat Pump, AC �aY(
MECHANICAL PERMIT APPLICATION FORM
Informa(ion Worksheet /C�
JOB STREET ADDRESS: ?g) q Sru�.1r, \P_.0 e l e �''''�(
CITY/STATE/ZIP: Sika n P q f (.o PARCEL NUMBER:
OWNER: C'ck.c- p‘r\c\SPHONE NUMBER: `1aa
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: AIRE VALLEY HEATING & Cooling LICENSE NUMBER: ATRRVtiT141f1-1
PHONE NUMBER: 924-0018
MAILING ADDRESS: N. 521 Ella Rd. 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 =
25.00
x
,V
waoasr0 �rN$��T .
GAS WATER HEATER x 10.00 =
GAS QUIPMENT<100,00�STU (INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA C UTLET) x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOI[EP/REFRIG 1,0001-1,750M S'�U x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HAAT PUMP&Aft CON ITION t 0 0 TONS :....:.:..' x 12.00 = / 00
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP &AIF CONDITIONER15-50 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP &ACR CONDITIONER:+50 TON$ ...... x 60.00 =
VENTILATING FANS x 10.00 =
x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
• TYPE II HO4t : :...»«: >>: ' _:: < :`<::: :: : x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE *. . .:< x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS(NOT COVERED ELSEWHERE x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINST D GAS APPLIANG >400,0 BTU x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
US O APP IANC �d Q,000 BTU x100.00 =
AIR HANDLER<10,000 CFM x 12.00 =
AIR HANrLR>1'0,OQ0M <.: x 15.00 =
SUBTOTAL $ la °"
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ 3`? o0
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 9 y