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1990, 01-08 Permit App: 90000095 InsertMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 4E. //5/O G�gce CITY/STATE/ZIP: 5POKA4IE /IJIA / 992k =PARCEL NUMBER: OWNER: JUJAIN) G. YVaovs MAILING ADDRESS: E, //.3/G 6e4cr PHONE NUMBER: 9 Z4-179tp (Street) CONTRACTOR: OWAat, MAILING ADDRESS: (City/S ate) LICENSE NUMBER: PHONE NUMBER: 19Za4 (Zip) (Street) (City/State) (Zip) MECHANICAL DESCRIPTION WORKSHEET/FEE SCHEDULE NUMBER X EACH OF UNITS UTNIT DUCTWORK SYSTEM WOODSTOVE/INSERT GAS WATER HEATER HEATING EQUIPMENT <100,000 BTU HEATING EQUIPMENT +100,000 BTU GAS PIPING (EA OUTLET) 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 CLOTHES RANGE DRYER OR 12' PTN. OF HOOD) 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 <10,000 CFM AIR HANDLER >10,000 CFM 1 = AMOUNT X$10.00 x 25.00 x 10.00 x 12.00 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 5.00 NOTE: M,NIMUM PEj2MI'Il FEE IS $35.00 SIGNATURE (/JjJh%n� }(0) JALOOA O SUBTOTAL 25.00 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ =V .6U Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675