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1991, 06-25 Permit App: 91003390 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM InformationCWorksheet JOB STREET ADDRESS: £ 15 3 ® ! /77 -,t SS 4-0A) CITY/STATE/ZIP: VnQ/A, DAL e PARCEL NUMBER: OWNER: W :-T LL . !A al'► Clue efq PHONE NUMBER: 9a v MAILING ADDRESS: C / a 3a9 /h S -Z O&` / Vek4 j C6 4/,4 e7903 ' (Street) (City/State) (Zip) CONTRACTOR: MARTIN SHEET METAL inc. LICENSE NUMBER: MARTISM170KW PHONE NUMBER: 924-8088 MAILING ADDRESS: BLDG. #103 SPOKANE INDUSTRIAL PARK SPOKANE, WASHINGTON 99216 (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH OF UNITS UNIT DESCRIPTION = AMOUNT ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/INSERT GAS WATER HEATER GAS EQUIPMENT <1000,000 BTU (INCLUDES GAS EQUIPMENT +1000,000 BTU DUCTWORK) GAS PIPING (EA OUTLET) BOILER/REFRIG 1-100M BTU BOILER/REFRIG 101-500M BTU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,001-1,750M BTU BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONER 0-3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR CONDITIONER 15-30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PUMP & AIR 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 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 a�. x$10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = 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 = 16,00 ea. G7 © NOTE: f,TNIMUM C� PERMIT FEE IS $35.00 SIGNATURE - )(- - 1, 1J Le c"� SUBTOTAL $x4400 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675