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1992, 12-03 Permit App: 92010601 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM /l Information Worksheet JOB STREET ADDRESS: /V. I' /) � ] KL CITY/STATE/ZIP: ). ii )/4 / 9z/ z- PARCEL NUMBER: OWNER: k13/')h i)o (hij PHONE NUMBER: 9,,?`>'�_Y3_3 MAILING ADDRESS' (Street) (City/State) (Zip) CONTRACTOR: lk1""CD /9/ c LICENSE NUMBER: )Q)/ CfW7 X/? Z: PHONE NUMBER:b3y/ (Z9-2,s-- -2_ MAILING ADDRESS. G S /�_ DESCRIPTION (Street) Vp�J L (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) `WOODSTGVE/INStT... GAS WATER HEATER GAS EQUIPMENT <100,000 BTU`(INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING (EA O)TLET) BOILER/REFRIG 1-100M BTU BQILER/REFRIG 101:--;500M BTU BOILER/REFRIG 501-1,000M BTU BOILER AEFR G 1,0001 1,75oM BTU ...................................... . BOILER/REFRIG +1,750M BTU HEAT PUMP &AIR.CONDITIONER:O 3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP &:AIR CONDIT`IONER;15 30 TONS;: HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PUMP & Alp CONDITIONER +50 TONS VENTILATING FANS EVAPORATIVE` COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) .TYPE II HOOD CLOTHES DRYER RANGE ` GAS LOG MISC L ANEOUS (LVOT COVERED ELSEWHERI UNLISTED GAS APPLIANCE <400,000 BTU .......................................................................... ULINSTED GAS':; APPLIANCE >400000 RTU USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 BTU AIR HANDLER <10,000 CFM AIR HANDLER >10,000 CFM: NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE /4) (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 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x12.00= /7ev /-,c� ��Kin x 20.00 = x 25.00 = x35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x10.00 = x 10.00 = x1.0.00 = x 504.1)0 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ ` PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE hh G� _$S/ /. a) Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675