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1991, 11-15 Permit App: 91007897 Mechanical Fixtures145.11-blyo P (lltssion P'wa5 MECHANICAL PERMIT APPLICATION FORM U s L 3 7 Information Worksheet JOB STREET ADDRESS: . • \)\ Q^\ " \-\•0...1c \P `,` CITY/STATE/ZIP i (1P \' - ad(p PARCEL NUMBER: OWNER9.3 ).*Q \r- E-1.c*.`e-\Q PHONE NUMBER: C\`a.F.- L\ScIO MAILING ADDRESS: f', e 1 (� `(Street (City/State) ` CONTRACTOR: V\e\ SSVP 'IutCe.LICENSENUMBER:\� PHONE NUMBERL-lszlo \ MAILING ADDRESS: Iv • ���) kiThl U\�\Ch ,VQ , (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE q1-1617 ftterk -I4 151-13 cacke-9 _N Lam. ��a\ (Zip) DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOOASTOVF/INSRT.:i:. n?' n'.i.':; GAS WATER HEATER GAS' EQUIPMENTcio0;,00a02:- 4134cs,:.::;::: GAS EQUIPMENT+100,000 BTU DUCTWORK) GAS'iP..IPING.:EA.OU7�:. BOILER/REFRIG 1-100M BTU • BQ1l,ERU.3EFRI.G':1:0.1`:1500 BOILER/REFRIG 501-1,000M BTU Pg! LER/REFRIG,:i7.':000;1.-1.75.4$ a BOILER/REFRIG +1,750M .BTU H EAT'NP.UMP;&:A(R:;CONDI,TIONER`;ViSCreNS;:', :. HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT`P..UMP,:& AIR;.CONDITIOfIEP45-30-TONS:> r:. HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT',P;..,U,MP: &IµAIFttpOND.ITION,Ea +50;;TONS;;;: VENTILATING FANS • TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE11rH00D'4'::'::., ;;`:''"i-;:r:;><:':.�.r:�,�,..;;;'i„ ,... :. CLOTHES DRYER ,.` GAS LOG MISCELLANEOUS'.(NOT COYERED.tLSEWHERE: ":.' UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS`AP.PL7ANCE?4Q0",'000:BTU'.:.:: USED APPLIANCE <400,000 BTU USED`AP.pLIANCE:>400,000 BT;G AIR HANDLER <10,000 CFM AIR 1LiANOCER1d000:CFM:;:`;::. NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE X_II`Ly-L\ \\ : J�-c3 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 = x 60.00 = x 12.00 = x 20.00 = x25.00 = 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 = 2, Qy. 03 `� Q , ©U SUBTOTAL $ Q(.5• , CO PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ •Q3 • Spokane County Division of Buildings West 1303 Broadway Avenue Snnkana WA oo9an fGno\ AGa oa7c