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1991, 12-02 Permit App: 91008285 Mechanical Fixtures4c)` -`,\A •\-v\ a to 04 -)MECHANICAL PERMIT APPLICATION FORM Information Worksheet NR' JOB STREET ADDRESS: 6-0/ ig S": /294 Ve / • Q'. - Qck 41 o , 3 5 5tf CITY/STATE/ZIP: 57'(7 7 9.-2-0 PARCEL NUMBER: 9, I -8zss OWNER: 73.2 .L % i6)//Y(ri l P it PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: /Q/,0 1i6,(:) , ./l C LICENSE NUMBER:, -2/E) A697"• / 9/ZT d .-- /iUPHONE NUMBER: 0�02`7•3.?.3 ?‘"00 MAILING ADDRESS: n a_7 ,-.. 9 mad 4. (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) �i '::Xjl•:xy A.=2. r'?SFX.?'S:vh.'•A:; ��.y{y���.�• .Y:M1y��!f)��y��'yyy :l{'�o- :�':.'.Yi..}ii�a'�st:} ti:r�-S �{2•.�1_-..:,- ::-_.v:n:vv:_ .w:..sn:::v.nvv..:.xY*....u:-:::..:.:..v. /.:w.... GAS WATER HEATER A GAS EQUIPMENT +100,000 BTU DUCTWORK) - n�{v:•.vs}:}_ ::-:.yv;: nv.:v,:-: n.:. R•::txY}-k BOILER/REFRIG 1-100M BTU O M,ose BOILER/REFRIG 501-1,000M BTU :«::::.,K.,��:.::::.,,.•N.x-.,; . .tom ,•. }> n..,,�::.w. ---- -:,:;..p.-- � :t' :,,,:,.. �s -wax =-; ar.,,w..•rs,, BOILER/REFRIG +1 ,750M BTU HEAT PUMP & AIR CONDITIONER 3-15 TONS i�'<F�t•-�..Mp��,tl��C� {-.-I�.. { ' •-.:�..E'�-. 7.:-.-I#�.:.'. HEAT PUMP & AIR CONDITIONER 30-50 TONS - 17.31:91,141111111" � & "fix: {;><::;:::.::_::::: :-.. •}.„saMa�,.,�_-:« �Ca...�:•c•,cc*,a:Y.,;x..-}.oxn-,�fX.:,vn=.}h:i`.{v`%:-;':3:. VENTILATING FANS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) - v Vn-v :•:x::rv::4�iy::�iv'- ......... . .....:::: ......... ..... CLOTHES DRYER GAS LOG MISCE AN S' :` ` COVERED SE IH UNLISTED GAS APPUANCE <400,000 BTU ULINSTED AS PPUAfi C 0 USED APPLIANCE <400,000 BTU .................................................................................... USED APPUA IG I,00 ;BTU AIR HANDLER <10,000 CFM AIR>HANDLEl >1 .000 CFM NOTE: MINIMUM PERMIT F IS $35.00 SIGNATURE 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 = x 20.00 = x 25.00 = x35.00 = x60.00 = 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 = x10.00 = 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 = /49."o /. az) SUBTOTAL $ / 3.0-c) PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 3g Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675