1993, 01-28 Permit App: 93000443 Heater4519-5,C)(10 L-io
a�\
e� \ILLS JB -j
JOB STREET ADDRESS: /0 '0
MECHANICAL PEHNIIl APPLICATION FORM 93.- 4,4%
Irformation=Worksheet 2148OC
/
nA /
CITY/STATE/ZIP: /0no.CPD4v 1O4-qqa-/,/PARCEL
OWNER:
/ / ��vc v� GI PHONE RE /$j oflp l///10 � n _ _ p
(Street) d
CONTRACTOR:10dAZ1-/Z4 ill")
NUMBER:
NUMBER:
LICENSE
PHONE
MAILING ADDRESS:00 a c 7177
(Street)
9c , ovo
I(,e.00g /4,(1429-1...2-
,,, (City/State) (Zip)
NUMBER: c5& A/2 - S/e - . 37a;Jf -
NUMBER: 4/L2 -,S?MC
ia-.1o, /./ii 99/7
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 ETU
HEATING EQUIPMENT +100,000 ETU
GAS PIPING (1 --4 OUTLETS)
GAS PIPING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT
REFRIG 101-500M BTU
PUMP)
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
VENTILATING FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12'
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
PTN. OF HOOD)
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 <10,0.00 CFM
AIR HANDLER >10,000 CFM
X$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
1
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 =
Y 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 =
/ .00
NOTE:MINI FEE IS $35.00
SIGNATURF,fylhen
Spoka e Cd Department of Building and Safer
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT - $ 1/45/1.4,81,
FEE DUE