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1993, 09-03 Permit App: 930007886 Mechanical Fixtures'J�` v; tai 1 t Mgg` ECHANICAL'FERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: F / 1 y ,I 3 P p-r-hee 2 CITY/STAT ZIP: 5 f rAn it</ /4/.f 7F;'/ PARCEL NUMBER: OWNER: ILL (/ FY/ .40,,^- PHONE NUMBER: Y. 7- /4/,c___ MAILING ADDRESS: c. Sn 7 / tun .C�mrna,oc , ,- 422- 970 / G (Street) !• . (City/State) '(Zip) (Zip) CONTRACTOR: 41p -r -Y0 /1\---. � b- LICENSE NUMBER: A)0a P 1,0 ALA Q 7/147 / / PHONE NUMBER: 5SY- -797.5 MAILING ADDRESS: R\ 170 -3 / ..--e-e-iti S -n v.v /- /f a ice,',i/�°% (Street) ( ity/State) J (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/INSERT GAS WATER HEATER GAS EQUIPMENT <1`00,000 BTU (INCLUDES GAS EQUIPMENT+100,000 BTU DUCTWORK) GAS PIPING (EA OUTLET) BOILER/REFRIG 1-100M BTU BOILER/REFRIG 101. 500M BTU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,0001 1,750M B BOILER/REFRIG +1,750M BTU :HEAT PUMP & AIR CONDITIONER HEAT PUMP ,& AIR CONDITIONER HEAT PUMP & AIR' CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER VENTILATING FANS .EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE,II, HOOD,_,.,..,;;. CLOTHES DRYER GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE'; UNLISTED GAS APPLIANCE <400,000 BTU • ULINSTED;GAS APPLIANCE 400,000 BTUj USED APPLIANCE <400,000 BTU ........................................................................................ USED APPLIANCE>400,000BTU 1 AIR HANDLER <10,000.CFM .......................:................................................... AIR HANDLER >10,000 CFM TU -. 0-3 TONS 3-15 TONS 15 30 TONS_„'. 30-50 TONS +50 TONS NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x12.00 = x 15.00 = x 1.00 = /i, On / A) ©n 4 4,7)O x 12.00 = x 20.00 _ x 25.00. = =x 35.00 = x 60.00 x-12.00 = .._ x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.0 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = - __._. _. . SUBTOTAL .-$ -Ail 0 0- PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ '''' Y -00 Spokane County Division of Buildings - West 13r"' Broadway Avenue Spokane, WA 99260 (509) 456-3675 C fr 4 4 3 1— — • L- I 'II ( 0 I— r DETACH 70 DISPLAY CERDPCATE _ . •if.. • •:.: DEPARTMENT OF LABOR AND INDUSTRIES :I fi • MS CERTIFIES THAT THE PERSON NAMED HEREON is REGISTERED AS PROVIDED BY LAW AS A Ij il • is4 • SEGISTRA1ONIF-4BS4 EXPIU1171341}' .:1.,NT2C.‘:Ht,07(11-1.106/21/951 i • . I : • ;40 CC Rcrk f`G g- AI:, CC. D INC dit A: 5t03 E TRENT AC • ri SPOKANE 9;!2I21151 P. STATE OF WASHINGTON I_ DETACH TO DISPLAY CSFITIFIDATT a Ha-042CM ‘3.4Z. cc C U. rc