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1993, 05-21 Permit App: 93003818 ACMECHANICAL PERK IT APPLICATION FORM Information Worksheet • JOB STREET ADDRESS: CITY/STATE/ZIP: 1/45171 £, / 3i& /Ya Crf. (�A 99A /(p PARCEL NUMBER: OWNER: Pj(V) «'I d trcr PHONE NUMBER: 9.-,Y MAILING ADDRESS: CONTRACTOR: A /00D MAILING ADDRESS: e. DESCRIPTION (Street) 0_/7 -ir .5/b3 ha.n/ (Street) (City/State) (Zip) LICENSE NUMBER: COCCC\Nl 17c'p ?, PHONE NUMBER: Y - L(C/ 75 - (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/INSER7: i':, . GAS WATER HEATER 'GAS EQUIPMENT:<100,000, BTU (INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) ieAS, P,IPING;(EA,OUTLE'T)..::: BOILER/REFRIG 1-100M BTU 'BOILER/REFRIG 01 5OOM BTU 7 BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG.1,0001 1,75.0M BTU:; BOILER/REFRIG+1,750M BTU ,HEAT°PUMP'&;AIRj CONDITIONER'0-S TONS: ` HEAT PUMP & AIR CONDITIONER 3-15 TONS HEATPUMP.&AIR CONDITIONERI5-30ETONS,-; T;:. HEAT PUMP & AIR CONDITIONER 30-50 TONS T .HEAPUMP & AIR; CONDITIONER"+50 TONS',; VENTILATING FANS EVAPORATIVE COOLERS •;:i::: TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) ;TYPE ILHOOD::>.;::'::.:::;;i:`:::::`::.....:,::..::.• . ,:...:...: CLOTHES DRYER GAS LOG •MISCELLANEOU&(NOTCOVERED ELSEYJHERE:;.:;::cs:: UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED;GAS'APPLIANCE_>400,000 USED APPLIANCE <400,000 BTU USED APPLIANCE .400,000 BTU AIR HANDLER <10,000 CFM AIR1HANDLER'>10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE West (Zip) NUMBER OF UNITS X EACH UNIT = 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 1.0.00 = x sO.tbo = xt00.00= x 50.00 = x100.00 = x 12.00 = x 15.00 = /a (Th SUBTOTAL $ f,&_12j + $ 25.00 PLUS: PROCESSING FEE EQUALS: TOTAL PERMIT FEE DUE LS7 _ $ Spokane County Division of Buildings dway Avenue Spokane, WA 99260 (509) 456-3675