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1989, 06-13 Permit App: 89001725 AC1n_4) `t /f9A-R .4. MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: Er / 041cI v /47/5 5/0 //J CITY/STATE/ZIP: 5-POKQne_PARCEL NUMBER: I- /7sri/-i3ri PHONE NUMBER: 92_1( - 677 / lril q ei 5" �o • /06/0 441 5570^1 spo/ j lef4r 9 o6 OWNER: 5T/o l ! I /(I `2RC D MAILING ADDRESS: CONTRACTOR: )('Q (Street) 1791-ey. I71.eUYCt9 (City/State) (Zip) LICENSE NUMBER: /4L25V11t2 /410 l PHONE NUMBER: MAILING ADDRESS: 6 )/7o rf 71&77 71- 6-0-2009 % D Spaced / e / zze6 (City/State s;.; (Zip)'- .(Street) MECHANICAL"WORKSHEET/FEE'"SCHEDULE NUMBER DESCRIPTION OF UNITS$ DUCTWORK= -SYSTEM. WOODSTOVE/INSERT•, GAS -WATER HEATER HEATING EQUIPMENT <100, 000 `BTU = ». z•�_ HEATING EQUIPMENT +100; 000 `BTU•: -.}_r: GAS PIPING 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-&- AIR CONDITIONER iC1737TONS: t'" ;: HEAT PUMP &-- AIR •CONDITIONER;3-15zTONS _. HEAT PUMP..& AIR .CONDITIONER .15 -30.= -TONS= HEAT PUMP,,&:AIR CONDITIONERl30=50:TONS bs:i HEAT PUMP & AIR CONDITIONER VENTILATING FANS EVAPORATIVE COOLERS HOODS CLOTHES DRYER RANGE GAS LOG UNLISTED GAS APPLIANCE AIR HANDLER - 10,000 CFM NOTE: MINIMUM P_RMIT FEE I8 $20.00 Signature . ,s. SUBTOTAL X'EACH •c, UNIT X X X.;::- 6 . X : :9:00.x= x" 11:00=5 x1'9.0 0'!= x -.16.50:1 x 22.50. 7 x.33.50:,= x 56.00,= x. ` 9:00' x `}16:50 x''22..50'd . x '33'50 X r56.06-4=' x 4.50 = x X 6.50r= x 6.50= x 6.50 = x 6.50'= x :20.00 = M. 49:0 0 r=.,'AMOUNT ., M'pe..+: r rp,;. . $ ..,`j , °" PLUS: PROCESSING FEE EQUALS: TOTAL PERMIT FEE DUE Spokane County Department of Building and Safety 1 u._J 40110 n.....1....... Annan. eww L..ww ■■■A nnfcn /Cnnl ACC OC7C •