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1992, 12-03 Permit App: 92010594 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS. /9,3„2/ unui arc �-1 CITY/STATE/ZIP:2/ ----C(:)C/ i/% A V" PARCEL NUMBER: OWNER: ,7----c7(CL c2 QC �C_� PHONE NUMBER:9c2'/ - 7y' MAILING ADDRESS* (Street) (City/State) (Zip) CONTRACTOR: /'-/2("() Ley- /&, 7 LICENSE NUMBER: /L// / (-//7)/7O -' PHONE NUMBERS 1/92S - MAILING ADDRESS: (-' - S� `� /f_z/t/ �' �''``). /__t%)/ 992/e DESCRIPTION (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) SAl D IN S GAS WATER HEATER:::::.:...................................................... • GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU BOILER/.REFRIG 10.1-55.00:M: BTU BOILER/REFRIG 501-1,000M BTU BOILER/RE t IG 1,0001 1,750M BOILER/REFRIG +1,750M BTU NEAT PUMP &AIR CONDITIONi=q..t)..:TONS.... HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR CONDITIONER 15 30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS ................................................................................................. HEATPUMP: & All CtNDITIONIR 450 TONS.. VENTILATING FANS TYPE I HOOD (PER 12' OR 12PTN. OF HOOD) YP CLOTHES DRYER RAN' GAS LOG ............... ................ MISOI NI UNLISTED GAS APPLIANCE <400,000 BTU UI INSTED GAS APPLIANC X400,000 RTU USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 BTU; ; AIR HANDLER <10,000 CFM ......................................................... . . .................................................................................................................. Alii HANDLER >10,000 CPM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE -6 (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x10.00= x 12.00 = x 15.00 = x 1.00 = x 12.00 = x20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x60.00= x 10.00 = x10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x1,0.00 = x5010 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = /4 CO /:\) . C/b ,,-2- (2} SUBTOTAL $ c./ ) PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ Zpr Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675