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1993, 11-15 Permit App: 93011064 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM Information Worksheet 1/ JOB STREET ADDRESS: _3.4 Q 7 S. in CITY/STAT IP• OWNER: MAILING ADORE S: l PARCEL NUMBER: , , PHONE NUMBER: 7.,°1 t 3 / v 6, t (Street) 'i , 1CIty/State) y� A (Zip) CONTRACTOR: /V /h 7�� ,A- - a i .. - LICENSE NUMBER: )v D PC 0 jI 0 ) 6 4 6 // PHONE NUMBER:p MAILING ADDRESS: K /a 3 �-„o-KI _57)41�2,i-+._ /.�l/.� 9901/i (Street) (City/State) J (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) W00DSTOVE/INSERT°: ;';:.: r: GAS WATER HEATER .GAS:EQUIPMEN "^ 1 U6;000 BTU(INCLUDES'.',..' GAS EQUIPMENT+100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU 'BOILER/REFRIG f01 5OQM $Ttl ,°: _: BOILER/REFRIG 501-1,000M BTU 'BOILER/REFRIG4;0001 1760M-6TU;'.''':.' BOILER%REFRIG +1,750M BTU HEAT;PUMP:&;'AIR CONDITIONER,0: 3 HEAT PUMP &.AIR CONDITIONER 3-15 TONS HEAT;PUMP S AIR CONDI FION fi 15=30,TONS: HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PUMP:$ AIR"CONDITIONER +50 TONS:':..`;i:=;;.:::: VENTILATING FANS EVAPORATIVE COOLERS.;'. <': TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE'IIHOOD................:.<:,: CLOTHES DRYER RANGE GAS LOG MISCELLANEOUS (NOT'. COVERED: ELSEWHERE;;:;;,...:. UNLISTED GAS APPLIANCE <400,000 BTU 'ULINSTED GAS APPLIANCE >400;000 USED APPLIANCE <400,000 BTU 'USED APPLIANCE>40,0,000 BTU HANDLER <10,000 CFM AIR, HANDLER >10,000 CFM NOTE: MINIMUM 'PERMIT FEE IS $35.00 SIGNATURE_JF ftp.`. 1°641 -PJ NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00= x10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 = x25.00 = x35.00 = x60.00 = x 12.00 = - x20.00 n x 25.00 = x 35.00 = x60.00 = 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' = m,no 11 �y rya :-R O Q -J SUBTOTAL - $ 27 00 PLUS: PROCESSING FEE . + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE' '-'-$4 9, nd Spokane County Division of Buildings West 130 ay _nue Spokane, WA 99260 (509) 456-3675