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1991, 09-16 Permit App: 91005865 Mechanical FixturesJOB STREET ADDRESS: MECHANICAL PERMIT APPLICATION FORM Information Worksheet q0a t) e` n ,b 1;1 CITY/STATE/ZIP: \/ ,(m e r)c) PARCEL OWNER: 0 Com.CCL MLS kaxoti..t d MAILING ADDRESS: q0r /1J . A gvb3j,, (Street) CONTRACTOR:) 01 MAILING ADDRESS: Po A 5-1 b i (Street) NUMBER: 160c5t1 -- b 055 PHONE NUMBER: J 0q - q , -0&60 (City/State) (Zip) LICENSE NUMBER: SE - /4 R - ,sfre - 370 Ai / PHONE NUMBER: cr-ect 1 3 45I X2.01-vue W4 9q,9-00 City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH .OF UNITS UNIT DESCRIPTION = AMOUNT DUCTWORK SYSTEM WOODSTOVE/INSERT GAS WATER HEATER HEATING EQUIPMENT <100,000 BTU HEATING EQUIPMENT +100,000 BTU GAS PIPING (1 - 4 OUTLETS) GAS PIING (5 OR MORE. EACH:) REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-500M BTU REFRIG 501-1,000M BTU REFRIG 1,001-1,750M BTU REFRIG +1,750M BTU HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & VENTILATING AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER FANS 0-3 TONS _ 3-15 TONS 15-30 TONS 30-50 TONS +50 TONS EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE II HOOD CLOTHES DRYER RANGE GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE) UNLISTED GAS APPLIANCE <400,000 BTU_ UNLISTED GAS APPLIANCE >400,000 BTU_ USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 BTU AIR HANDLER <10,000 CFM AIR HANDLER >10,000 CFM x$10.00 = x 25.00 = x 10.00 = x 12.00 = x -gere1O- = x 1.00 = 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 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = . © C1 NOTE: MINIMU PE IT FEE IS $35.00 SIGNATUR ,j 4, / 4/al O eket_O Spoka e CI ty Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 SUBTOTAL $ 00 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE