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1991, 10-07 Permit App 91006591 Furnace, Wtr HtrMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 4 . / 7 (p oc.,I , ,i a.2 CITY/STATE/ZIP: H cam, R-64•4%4 PARCEL NU BER: OWNER: metre )27 c Cet// PHONE NUMBER: - 7d 7/ MAILING ADDRESS: - 65v (Street) (City/State) CONTRACTOR: AIRE VALLEY HEATING & Cooling LICENSE NUMBER: ATRFVHT141 OH PHONE NUMBER: 924-0018 99212 MAILING ADDRESS: N. 521 Ella Rd. Spokane, WA (Zip) DESCRIPTION (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQUIPMENT <i00'000 SY:U':.;1NCLUID.ES GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU ......................... ROILERIIEFFUG 1 v::0;t BOILER/REFRIG 501-1,000M BTU • C 1L i 113EF.F tG:`` io.0:01 7$0 BTU BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONER 3-15 TONS :HEAT PU:.MP & J IR CO:NDITI:O,NER 15 =30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS >F I:RATit? ):IVI.P AIR>CO:NDITI: J:NER>+50 TONS<><> VENTILATING FANS:.:::............................................................. ;..�,rr; ..rav:!<<r: �: �>r;•:+r:i`:.:v.,v.:.:..�-e�::.v.::>a:::a::,is:a:::::::5::::::: � :: � :::::>:i �::as TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER GASLOG ::.::::.............:......:.................................................................... ...................................................................................... isi MISCELLANEOUS (NO:T COVERED ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANCR i00,000 BTU USED APPLIANCE <400,000 BTU USED APPLIANCE :00,000 AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x12.00 = x 15.00 = x 1.00 = x12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x12.00= x 20.00 = x25.00 =• 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 = x50.00 = x100.00 = x 12.00 = x 15.00 = /a "- / /.02 0 0 SUBTOTAL $ Y, QJ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ 17 do Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675