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1992, 08-19 Permit App: 92006600 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: - 3 0) %O6J Q /:_c/-1 X30 CITY/STATE/ZIP: S/bx/44/ GJ/9. J>.?06 PARCEL NUMBER: OWNER: CO L GnJ C y PHONE NUMBER: 1.2 `/- T'o S` MAILING ADDRESS: S. T0/ 7 /TOCc)yp /S "4- P -e06 (Street) (City/State) (Zip) CONTRACTOR: '09 7-/04v/9 - CN///7/1/t/ S'( -__LICENSE NUMBER: I/4 % /0 /oo K q PHONE NUMBER: I as -0260C) MAILING ADDRESS: C %8/' /Tie() ' / uhe9 Y PA' 1, )4 99 O (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) V.V..QQ.psToy.:g104.$EIT:> .................................................................................................. . GAS WATER HEATER ...................................................................................................... ;GAS f'Mt=t 100,4'('U (INCLU0 GAS EQUIPMENT +100,000 BTU DUCTWORK) ............................................................................... .............................................................................. .. ........................ BOILER/REFRIG 1-100M BTU ................................................................................................................. ............................................................................................................. .............................................................................................................. BOILER/REFRIG 501-1,000M BTU BO:ILERFREFRIG 1:,0001 1 750M STU: :» BOILER/REFRIG +1,750M BTU HEAT<PUMP &; AIR CONDITIONER` 0-3 HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AD GONt TION ER 5- 0 TONS< ............................................................................................................... ................................................................................................................... HEAT PUMP & AIR CONDITIONER 30-50 TONS ............................................................................................................. HEAT::PUMP:&'ALf CO It 1TION.ER +5Q:7'QI�IS ............................................................................................................. VENTILATING FANS EVAP................................................................................................................. .................................................................................................................... ..................................................................................................................... TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER ..................................................................................................................... . RAN GAS LOG M.ISCELLAI E'*C US:. NOT'>GOVERED ELSEWHEF 1= << >> <: UNLISTED GAS APPLIANCE <400,000 BTU .................................................................................. .............................. . ULIN TEI)' A >APPLIAN E>40 :, ...........................................................................................: USED APPLIANCE <400,000 BTU AIR HANDLER <10,000 CFM ................................................................................................................... NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE G✓ Ong Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 (Zip) N moGSA- obK 9 NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = 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 = / / SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE y = $ jU .,c5::