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1993, 05-27 Permit App: 93004039 Mechanical Fixtures
MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS:. /� ,ID14P1 CITY/STATE/Z P: s ,yzf 6 PARCEL NUMBER: OWNER: G i` CI ll hi` e PHONE N MSER: - /44 MAILING ADDRESS: (Street) CONTRACTOR: .AC.7 (a►,4rbIs (City/State) (Zip) LICENSE NUMBER: 4c T (CT (7d$/l/ //�� `� PHON NUMBER: 79 - SC /% MAILING ADDRESS: r0 K //%7 J/ t� [>�u •6 . CVd6 DESCRIPTION (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/INSERT GAS WATER HEATER GAS EQUIPMENT <100,000 BTU (INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) G S P PING (EA OUTLET) [` OILEEFRIG 1-100M BTU BOILER/REFRIG 101 500M BTU': BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,0001 1;75QM BTU BOILER/REFRIG +1,750M BTU HEAT PUMP;& AIR CONDITIONER 0- TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIRCONDITION Rya -+30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PUMP & AIR CONDITION R +50 TONS VENTILATING FANS EVAPORATIVE COOLERS v TYPE I HOOD (PER 12' OR 12' PTA. OF HOOD) TYPE 11 1-1 CLOTHES DRYER RANGE :&S LOG miSCELIANEOUS (NOT COVERED ELSEWHERE .>«uSTED GAS APPUANCE <400.000 BTU uuNSTED GAS APPLIANCE >400,000 BTU USED APPLIANCE <400.000 BTU USED APPLIANCE >400,000 BTU J$ . HANDLER <10.000 CFM AIR HANDLER >10.000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE 1)aw �Jo� NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = / x10.00 = �n x12.00 = x 15.03 = x 1.00 = x12.00 = x 20.00 = x 25.00 = x35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x10.00 - x 10.00 - x10.00 - x 10.00 - x 50.00 = x100.00 - x 50.00 = x100.00 - / /-2- x12.00 - x 15.00 = SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ q9� Spokane County Division of Buildings Inrn;t 1'109 n,,,-:' *'qv /1\/nt u Cnnlr7nn \NA (nor n (rrrn\ 4" ')P. -.7c