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1991, 07-08 Permit App: 91004047 Mechanical Fixtures
MECHANICAL -PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 0 ' /9 &C) a.Zr,y CITY/STATE/ZIP: 5 p 1 v\e c_._\ 14 PARCEL NUMBER: O %Srse'a -- / 7a_3 OWNER: cT. re ii./, j�r,A/k - PHONE NUMBER: MAILING ADDRESS:f/%,e� f�e.?.ec.it 3 ---`3 (Street) l' (City/State) (Zip) CONTRACTOR: G'0-,“ J1v.,m.4 })eaN',rx�J LICENSE NUMBER: Co /.0166 /5<'D 9.e3 PHONE NUMBER: `-,3 - ' MAILING ADDRESS: n) S emTh E.l g vm -Na,Ae A 9990 .s (City/State) (Street) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER $4 GAS EQUIPMENT+100,000 BTU DUCTWORK) -_. h:. -.e'-: acre -:s>. .rt-• a+it�` BOILER/REFRIG 1-100M BTU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG +1,750M. BTU HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR:CONDITIONER-30450 TONS VENTILATING FANS.,. .. 'EYiIt<:_t�wNw`vs t �� ' -s • 4 : .-..�::::.:: ..... . :tvw.x->::..�. .....i7�>'a.,,G TYPE I HOOD (PER 12' -OA 12' PTN. OF HOOD ..: x: :>•n�v::::. _: v e •••• CLOTHES DRYER RAN:G:F=<' - ..:....::::..:::.....:: GAS LOG K f1\ S hF• MISCEI.LANEOkJ N0 C01iEF EQ ELSEW UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GASAPPLIANCE>40( USED APPLIANCE <400,000 BTU US ? LIANCE O0O OTU AIR HANDLER <10,000 CFM AIR HANDLER >1 O OOO C:RM B' NOTE: MINIMUM PERMIT FEE IS $35.00 (Z ) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00= x 10.00 = x12.00;= x 15.00 = x 1.00 = x 12.00= x20.00= x25.00 = x 35.00 = x 60.00 = x12.00 = x20.00= x25.00= x35.00; -x 60.00 ' = x 10.00'= x10. = 00`-: x 50.00 Y= x 10.00 = x 10.00 = x 10.00 = x 10.00 = x10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = /a- 'ID / / - 'I- .x12.00 . F: A' .. SUBTOTAL $ / 3 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE eD _ $ 3rf SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675