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1993, 01-28 Permit App: 93000470 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: ' 9// CITY/STATE/Zip: �p. r to OWNER: ,t&ni _ & t % a /---e64-1 MAILING ADDRESS: 47/ 1 (Street) LA-5-uTo PARCEL NUMBER: PHONE NUMBER: `9 /y 2 VOC9 r !J-�fJA Ul er 9;6 6 (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Zip) (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) :WOODSTQVEIINSERT GAS WATER HEATER GASEQUIPMENT <100,000:BTU (INCLUDES, GAS EQUIPMENT+100,000 BTU DUCTWORK) GAS; J.PJNG_.(EAOU 's:1 -y r.:., BOILER/REFRIG 1-100M BTU ,BOILER/REPRIG_l01-500M°BTU :::rS BOILER/REFRIG 501-1,000M BTU •BOILER :../pEFRIG1 X0001-1 °,750M .67U.[°''::; BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONER 04:T,ONS;. HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT:PUMP.&AIR CONDITIONER 15:-30'TONS_ HEAT PUMP & AIR CONDITIONER 30-50 TONS HEATPUMP &AIR CONDITIONI R +50..TONS'.:::: VENTILATING FANS EVAPORATIVE. COOLERS.::' .................:.:.:.......... TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE'dU_HOOb CLOTHES DRYER GAS LOG MISCELLANEOUS (NOTCOVERED?ELSEWHERE "::: UNLISTED GAS APPLIANCE <400,000 BTU .ULINSTED:GAS APPLIANCE:>400000, BTU.: USED APPLIANCE <400,000 BTU USED' APPLIANCE.>400,000:BTU::: s [::.:;' AIR HANDLER <10,000 CFM AIi3.HANDLER')10,000 NOTE:, MINIMUM PERMIT FEE IS $35.00 NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x12.00 = 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 = /x,00 /, rte) SUBTOTAL $ f3.00 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE �� = $ °i Z� 3,(D SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675