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1992, 10-06 Permit App: 92008450 MechanicalMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS:_ S /Uv5` iou''4":_ )?w 6/1Z-- d,ttS /S7- ( --& ST(---& RIO CITY;STATE/ZIP:'" X�Xa, Gsl,�, PARCEL NUMBER: 593, 0%O(p OWNER: 14A PHONE NUMBER MAILING ADDRESS: SMITHQ (City/State) (Zip) CONTRACTOR: E. 102 NO` A LICENSE NUMBER: (509)328-4431 PHONE NUMBER: MAILING ADDRESS: WAYNESH25" (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/INSERT GAS WATER HEATER GAS EQUIPMENT <100,000 BTU (INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING `(EA OUTLET): BOILER/REFRIG 1-100M BTU BOILER/REFRIG 10.1:-500M BTU BOILER/REFRIG 501-1,000M BTU BOI LER/REFR IG:1,000.1=1,750M BTU. BOILER/REFRIG +1,750M BTU HEAf.00MP & AIR CONDITIONER 0-3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR CONOITIONEW15-30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PUMPA AIR.CONDITIONER +50 TONS VENTILATING FANS 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 <400000 BTU ULINSTED .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 . NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE 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 = / y t , SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ 'y-e/vv .. Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675