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1992, 10-05 Permit App: 92008441 Furnace, Piping• MECHANICAL PERMIT APPLICATION FORM 5 -%information Worksheet /'/ JOB STREET ADDRESS: //371 I /Z L.0%'% Cr -IL 42--e t CITY/STATE/ZIP• S'ODL / w 706 PARCEL NUMBER: OWNER:l7 -E )Q%di//✓6- PHONE NUMBER* @2? OtS- MAILING ADDRESS: %' '' (Street) J (City/State) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Zip) (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS G1UtPtv1 IV 3.00s09;G,1; 1 U INGl 105g8•5, >�GAS EQUIPMENT +100,000 BTU DUCTWORK) 'V _ S' I I T��ry}y'� 2"'`..<<,s\ BOILER/REFRIG 1-100M BTU BOILER/REFRIG 501-1,000M BTU ,I)a`(L 0100. „GA1cOgRi OMleT BOILER/REFRIG +1,750M BTU TPUtYfp:&i1IRG0«OitiC3t EF3.0 HEAT PUMP & AIR CONDITIONER 3-15 TONS npUMp 8„AtOO,Pirapt agkinola HEAT PUMP & AIR CONDITIONER 30-50 TONS >H. A1501/OraWaartilirKWEWW03r VENTILATING FANS '' APDRA. GCSQtEF TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) p� (IHO(31?Y CLOTHES. DRYER * S::F >,� aNG� _' '.:.. '� , .. Safi::,. <,y:•x• . �;.a �<: GAS LOG<.F iI<itl.S,CE°u_,AN O.(iS:':(NfJ't';CQV:01Eb im[S wo UNLISTED GAS APPLIANCE <400,000 BTU ULIINST.ECd'6AS�APptt itE=SAdQ b USED APPLIANCE <400,000 BTU USE D. APPL1ANQQ 4O O90 BTU >! AIR HANDLER <10,000 CFM I -HANDLE54616166'CP NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE - Rip) NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x25.00 = x10.00 = / x 12.00 = x 15.00 = x 1.00 = x12.00 = x 20.00 = x 25.00 = x 35.00 = x;60.00 = . . x12.00 = x20.00 = x25.00= x 35.00 x 60.00 = x 10.00 = x10.00 = x50.00 = x10.00 = 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 = SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ BB'" Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675