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1993, 05-17 Permit App: 93003582 ACMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: e 3 ?/ �. CS --'L tom_ CITY/STATE/ZIP:, n a-1 U 7k • 9 % /3 OWNER: a-yYVY1'l-F.-'yt et MAILING ADDRESS: , iba-1 PARCEL NUMBER: PHONE NUMBER: (?'� 75S y(Street) CONTRACTOR: 0 )-.2f • MAILING ADDRESS:7PC • /3L/L19 (Street) DESCRIPTION (City/State) LICENSE NUMBER: PHONE NUMBER: (Zip) AJL'R f c/639'3-GeS' (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) ............................................. IW9O0STOVFJINSSRT :. GAS WATER HEATER GAS EQU P1�1 IT> 100 000 BTU (INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS. PIPING. (EA;Q TLET) :. BOILER/REFRIG 1-100M BTU AOIt ER/REFNIG;a01 S00M BTU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG +1,750M BTU ........,';e':Si::'`.'•f>d;.:w w• r,.7.n',�yw►r;:S:::ttLw•::a;M HEAT PUMP & AIR CONDITIONER 3-15 TONS k1 T PUMP a IR.CONDITIONERy:; -�30 HEAT PUMP & AIR CONDITIONER 30-50 TONS <HEAT PUMP & AIR CONDITIONER *50'TONS' VENTILATING FANS 111,1;¢•\�.;'•.M„FA {Jl: TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG ISOE�.�.ANEOU . (NOT COVERED E SE WHEF UNLISTED GAS APPLIANCE <400,000 BTU �l� INSTEt GAS APPLIANCE >400,000 .TU . USED APPLIANCE <400,000 BTU USE(? APP LANCE 00,000 UTU :. : < AIR HANDLER <10,000 CFM DLEI 10,00Q :CFM...:......::.: NOTE MINIMUM PERMIT FEE IS $35.00 SIGNATURE )y) kC 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 = x20.00 = x 25.00 = x 35.00 = x60.00 = x12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 10.00 = x10.00= 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 = / /,_,? -00 x 12.00 = x 15.00 = SUBTOTAL $ / -Oh PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ ,---3%co /U2 Spokane County Division of Buildings WaQt Rrnariwav Atinnlln Cnn4ninn VA/A 00')R!1 M/1(]' AKa