1991, 09-24 Permit App: 91006193 Furnace, PipingMECHANI• PERMIT APPLICATION FORM •
Information nWorksheet
• JOB STREET ADDRESS: /I!. /t20'1.0 D) / /i o a a.d
CITY/STATE/ZIP: S/Boko,n 1,a A-- PARCEL NUMBER:
OWNER: Accks 'i-- , OQ+ctr PHONE NUMBER: 9.2/-7f7/ / Id?- g21/
MAILING ADDRESS:
(Street) (City/State)
CONTRACTOR: AIRE VALLEY HEATING & Cooling LICENSE NUMBER: ATRFVIITT141OH
PHONE NUMBER: 924-0018
N. 521 Ella Rd. Spokane, WA 99212
MAILING ADDRESS:
(ZiP)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
:{{yy j y/�I �jr� `x's" I<'' k 4'@. o � S
:.^. 1...: it n •?:.^..1 vA .^l k. iv a :. '.'.va56.:e..
BOILER/REFRIG 1-100M BTU
gRafigergakqe
BOILER/REFRIG 501-1,000M BTU
ItPlialtangtatra
BOILER/REFRIG +1,750M BTU
fitittatkialliatMe
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HINIKONNOTHEMAINIOr
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD)
' j..Qs ,..adi y'
a.�tir:::e.::..::Ca.?.�a°x,�^w�.a%zxazkc�?
CLOTHES DRYER
Nor3;, .z.
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
f ttaNdIESI/CIVPA710 `,0O1) B;
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
WITIMITOOAm
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
may_
x 15.00 =
x1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x12.00 =
x 20.00 =
x 2s.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 =
a`'
SUBTOTAL
$ .2.460
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ _57/20
SIGNATUREita Qet � 0 _
O Spokane County Division of Buildings
PK/
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675