1993, 03-11 Permit App: 93001414 Mechanical FixturesIrform-etion Worksheet
JOB STREET ADDRESS: h Q iy,,,,__ •A
CITY/STATE/ZIP:4n?l11 CP./.9- PARCEL NUMBER: �� 4 6
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PHONE NUMBER: � 7 -sr./76
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OWNERS,/ . i ,i4r4i
M.AILI ADD! SS: -r7 3 -/R % 2 �,Q�J, .. 99, -
(Street)/�//(__City/State) (Zip)
ef 11/ LICENSE NUMBER: 4
Sy'-,€ -6,A?-32 4/7^
CONTRACTORJO
PHONE NUMBER: «L; 8,5-
MAILING ADDRESS: &) 4 3'26''2
(Street) 7
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
(City/State)
DESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 ETU
HEATING EQUIPMENT +100,000 ETU
GAS PIPING (1 --4 OUTLETS)
GAS PIRING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12'
TYPE II HOOD
OR 12'
PTN. OF HJO i)
CLOTHES DRYER
RANGE
GAS LOG
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
(Zip)
OF UNITS UNIT I = AMOUNT
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x lj .
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 30.00 =
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 =
/0, O:
/.00
/0 . o ,
NOTE:'I .A
SIGNATURE ��- 4 01,10. 111,0 1a.R i /.i
Spoka e C ' Department of Building and Safety •
West 1303 : roadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_. S 4 . esa-