1992, 01-27 Permit App: 92000463 Mechanical FixturesmtInInwML n
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Information Worksheet / 'e.E 7"f" •
JOB STREET ADDRESS: l k -('"LO 5
`
�n F �F W4J�Q 3 8a.
CITY/STATE/ZIP:
Q PARCEL NUMBER:
(es/n-6)6
OWNER: /[D" Q, PHONE NUMBER:
MAILING ADDRESS: a�-t %- •w41Q-Sl,
`�
(City/State) (Zip)
CONTRACTOR: S a C LICENSE NUMBER: factict b$ -t4 -t ( o ( L7
PHONE NUMBER:
(Street)
MAILING ADDRESS: -It Si I.iYQ_40 14
• (Street) (Cit
State)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT
L'4-
(Zip) i92,04
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
NOTE: MIRIM PERMIT FEE
$35.00
IGNATURE
�t:er E=r .. a..i
Spokane Minh, nonartment of Bulidino and cafe
t.
SUBTOTAL
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.190 =
x 4.00 =
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 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
l Qom_
1t -
ISP
PLUS: PROCESSING FEE
EQUALS: TOTAL PE
FEE DUE