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1991, 12-02 Permit App: 91008290 Mechanical FixturesJOB STREET ADDRESS: MECHANICAL PERMIT APPLICATION FORM Lrformation Worksheet \1• a -y6 -, Q voter q1-8290 1OLeck N0. )sa3 CITY/STATE/ZI• IN PARCEL NUMBER: OWNER: \\-\\ ik ------\\-•0 sJ,, 1 PHONE NUMBER: (fl , .1-(y 6 MAILING ADDRESS: 'ec1,( (Street) (City/State) ` (Zip) CONTRACTORQ\1. ` \ C" -Q PCt)1CQLICENSENUMBER: \'pIMCI\,'P SSM`, - PHONE NUMBER: � ��• • MAILING ADDRESS: 5 \U\�\MN ®-"\�� vc \'P (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODS7.OV I ;; GAS WATER HEATER GAS�EQUIFMENT}}� Q40oo`�� GAS EQUIPMENT+100,000 BTU GAS f?IP1VG (EA:O10.1t EI m54 A..vuvv:e. ' BOILER/REFRIG 1-100M BTU goltLE (RE RIGi10 5b ,6f>° BOILER/REFRIG 501-1,000M BTU ..0),(01:441:00,41.0a2.., BOILER/REFRIG +1,750M BTU HEAT?,,P:,,U;M:P & A'fR,COl1p1710NER .640:.4NS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT:PUMP&''gi,9CONAITIOI[E5f5 .30 T0.(JS';`;:; HEAT PUMP & AIR CONDITIONER 30-50 TONS HATPa�CONqTQER+VENTILATING FANS - EVAPOFjAT1V1^W6L'"ERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE IIFQOD' :i CLOTHES DRYER GAS LOG • MISCELLfNEGU ""' ...,,,,.::.,�.,.�..:V...S�q,J9C0\iE,�iE4',EkS.Ei!N!HmRE::': UNLISTED GAS APPLIANCE <400,000 BTU ULINSTEDGAS`AFP4IANCEOO600h'BTU:;::.: "',: ;" USED APPLIANCE <400,000 BTU .'USED,APPLIANGE;?A00T000p6TU :. AIR HANDLER <10,000 CFM' AIR HANDLER''»,0000;CFMt 'INE�UDES'�; wAw.wn,w.,4nT. N: DUCTWORK) NOTE: MINIMUM PERMIT FEE IS $35.00 , SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00 = x 10.00 = x12.00 = 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 = 1a.0i1 t \.CO SUBTOTAL $ V'6,CO PLUS: PROCESSING FEE + $ 25.00 EQUALS:. TOTAL PERMIT FEE DUE =$33.00 Spokane County Division of Buildings West 1303 Broadway Avanoa Snnkano we ooOan IGno\ ACa OC -7L