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1991, 03-14 Permit App: 91001098 Fireplace, PipingMECHANICAL PERMIT APPLICATION FORM e . p InformatioW"worksheet JOB STREET ADDRESS: CITY/STATE/ZIP: PARCEL NUMBER: OWNER: PHONE NUMBER: 7,S_lC_ MAILING ADDRESS: /t/ 3 go-,/ (S7eet) (City/State) (zip). CONTRACTOR: LICENSE NUMBER: A?/ PHONE NUMBER: MAILING ADDRESS: 12? (Street)ty/S te st;ts)7 0i MECHANICAL WORKSHEET/FEE.SCHEDULE NUMBER x EACH DESCRIPTION OF UNITS AMOUNT'-:. : UNIT . .'' ; - DUCTWORK"SYSTEM .'-..s�-WOODSTOVE/INSEO 77 GAS <100,000 BTU .--. HEATING .'EQUIPMENT +100,000 BM AS.: PIPING:.'.: -(EA OUTLET) -x$10. 00 '2 SA 00 x:idis X:15.00 • x 00 i' 'REFRIG X101 500M BTU % FRIG5011':000M: X,,:20.00 "'" X`-�.25� 0 r, `REFRIGx 01 lF..750M.-'.BTU:.,-,, 0O -:BTU(NOT A/C OR HEAT.o PUMP )l--,:'., X 'REFRIG X101 500M BTU % FRIG5011':000M: X,,:20.00 "'" X`-�.25� 0 r, `REFRIGx 01 lF..750M.-'.BTU:.,-,, 0O FRIG`7+l-,_ 750M.�-BTU%.:'" x 60 00-,;. -- ............. z TIPUMP Ak - ',�! ­* " EAT- -VUMP,�; fi-'�.AIR 'CONDI TIONER,�l!��15�. 0 'REAT', PUMP" -3V.�TO IR*.CQNDITIONER'15-! 4 c. *..=i- NS Y X. HEAT, 'P:1��'AM CONDITIONER 30,�4 PUM 1TONS &:.AIR HEAT'- -PUMP.. CONDITIONER +5 0�;'_TONS VENTILATING`�': FANS ,."..EVAPORATIVE -COOLERS TYPE. I:: HOOD -121. PTN .(PER .12T OF' HOOD) TYPE II.HOOD CLOTHES'DRYER — — ----- — — — — — — — RANGE — — -------------- GAS LOG LOG — — — — — — — — — — MISCELLANEOUS (NOT COVERED ELSEWHERE)__ UNLISTED GAS APPLIANCE <400i000 BTU' .UNLISTED GAS APPLIANCE >4008000 BTU. USED APPLIANCE <400j000 BTU - — — — — — USED APPLIANCE >400,000 BTC — — — — — — AIR HANDLER <10,000 CFM — — --— AIR HANDLER >10,000 CFM — — — — — — — — — — 6*. .00.* 00' 10.00...r X::60.,00 X 10. 0 0.. x 10.00.,= . x 10.00 :,= x 10.00 - 10.00 = x 50.00 - X100.00 - x.50.00.= X100.00 = x 12.00 - x 15.00 = ............. z F" LSUBTOTAL $ lif e IPLUS: PROCESSING FEEJ+ $ 25.00 EQUALS: FEEADUEERMIT- NOTE: MIN 4" PERM 71 FEE IS $35.00 $ SIGNATURE Sokane CountyDepartment of Building and Safetv West 1303 Broadway Avenue Spokane. WA 99260 (501 459-1R75