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1991, 12-04 Permit App: 91008354 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM Informationf�Worksheet JOB STREET ADDRESS: / 2 7 Ai/"cc.v-i- 4/1//Z . 99'2 v,� CITY/STATE/ZIP: 5frev a /N..f PARCEL NUMBER: OWNER: 1)6tii S'i PHONE NUMBER: MAILING ADDRESS: (Street) n� CONTRACTOR: !, '/ ,s a w!e- r (City/State) (Zip) �J LICENSE NUMBER: � anis5) f 2 6i 1 PHONE NUMBER: 222 - 376 '/ MAILING ADDRESS: .S i( A) r/i b- , .5/2o� �741 (City/State) (Zip) DESCRIPTION (Street) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) 'GAS WATER HEATER saw•>.:�;-v'x:,;:�rx::s �:;�s.� :,;��-<�;=.w GAS EQUIPMENT +100,000 BTU DUCTWORK) "?- BOILER/REFRIG 1-100M BTU • t1. BOILER/REFRIG 501-1,000M BTU N .x{r .vN•vfre:.wsgwi'l 'f,.F {y � BOILER/REFRIG +1,750M HEAT PUMP & AIR CONDITIONERS:ASO t VENTILATING FANS . TYPE I HOOD (PER 12' OR.12':PTWOFHHOOD) CLOTHES DRYER GAS LOG UNUSTED GAS APPUANCE <400,000 BTU ✓..; . ?�`•..•.t4,%moi. ?�J.�.... :s;ttt USED APPUANCE <400,000 BTU ,... x�. ry.. Y, �•.r .kms,, AIR HANDLER <10,000 CFM ... .......:::}.ti!v:::ti..-.xr}xi:^{i:.v:::i: i:,r' L hr :Sh' ori NOTE MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00 = x10.00= a /e'.a-D x12.00 = x 15.00 = x 1.00 = x 12.00 = x20.00 = x25.00 = x 35.00 = x 60.00 = X 12.00 =`' � ,x20.0o •. x 25.001= x 35.00 _ x 60.00 = x10.00 :_; x1000-'=; x50.00 = x 10.00 `_ x10.00= x10.00 = X 10.00 = X 10.00 = x 50.00 = x100.00 = x50.00 = x100.00 = x12.00 = x 15.00 = /2. '2r 0-0 . .i z . , .,4 > �, SUBTOTAL $ 2 y. o't PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675