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1992, 06-24 Permit App: 92004249 Water Heater4509 9 3 07(i/ 'be) ` FA4 gS Add 8r (P MECHANICAL PE TIT APPLICATION FORM I^rmation Worksheet - D`t JOB STREET ADDRESS: • / SSD (1 /Al l 5S I &� 3 J CITY/STATE/ZIP: C7L zf\J G'IO I 1p PARCEL NUMBER: OWNER: �`/ rLj P1 Eie-- PHONE NUMBER: MAILING ADDRESS: CONTRACTOR: (Street (City/State) (- A-Q--�S � l� � LICENSE NUMBER: MAILING ADDRESS: (Zip) PHONE NUMBER: LIZ •Jx 1 . B l l i S Sf)z 9gao? (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) :: 7'd-O?I r : �:• I .• ::v:• :Y4?i44,k:Y {���.}i.':i�}iTi;:}:2 M1.'{i}::::•`.:::4:' GAS WATER HEATER GAS EQUIPMENT +100,000 BTU DUCTWORK) 4. F.v .{•: n}�:?. r.,•rlK:v.' `$'4,�',{: �"�,,:¢¢ :yC.r, +'d`r.:4•r`v: }.:v: is ;w�:. }.,, •:fiau:w:::}}''k,:••}: .....,,c'� },e.%, BOILER/REFRIG 1-100M BTU :....:....::. A7: ''•w.:'.x.:?}:Y:.::. ti\:vt•Y$`p+:.•.N::fi: %{•, :;•:'^.v? ::..:.•y$:::vt:...v BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG +1,750M BTU :.}t:.::.i}v:: 4:..:,v :.kv y r.•.•.v xY.I:. r :.;�.f:. n}'J.4•:.}v4•:{:.•:.: .n}YN.;: - ...•.•:k:ri{,v:nv:x;G.v.•.va.::.:•.~y�M�;j�/:^�.��i v.�•�xi-.,4rt�ri�.`.:-•.4.:}}: :::.G•:.v:.,•::.0{. '��:::i: �.t }�?E•'4 HEAT PUMP & AIR CONDITIONER 3-15 TONS 1s'.•7tr iTM•.W.•..vhv'vt••. ,.~ ` ~ 0\v,?:•.•}x::.i' •.:4. .:{vh• HEAT PUMP & AIR CONDITIONER 30-50 TONS !a�";.:k±r?w` vii: F �►`i:'ti' VENTILATING FANS 't:: TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) FIT4"~sFr:>.•:.'{•:r~v~•* CLOTHES :tr•::{.,�f0i`' DRYER .{:}:.:.,:.:4:$:•:Y:.'x�'dC•tgL. { �• •, .:p,^�~�, .,,��,?$}-4}y4:. .}}c;... - 2s: '.:;#:r:}:<{3u:::},.4>5F"• r.{ .t•.•••;�, .:c, i• ..+�'�•.`•:u:3.:{.?::•w:4;}:•:}r:.{{?fi',:!�{%'.•'t<•::A.i�t�f,K;•:`•it:0};::C/,•,:;: • ....... C..v2}s''�. t{{{.{ .:•.'r::crv~{: ::}..{::..:t:v t::{:4.4x?:::: v•. :+}.:•.::.4k}:::.}}:4: GAS LOG UNLISTED GAS APPLIANCE <400,000 BTU U4NCE*OOO ' ' 14: >,:, . USED APPLIANCE <400,000 BTU . ?;.t; {{::{::::•ray,...,:, .:.... :2.}:{:�%ry;•rc:::A3Y{j,:.::.':}.,••}f{ :!417{A�"��A}���i�rf•.�•VV�3;7#ik:�~R.�'.;:r{, %r 8 �l{2 ''�'���f,�•{}�?'f"4•t. AIR (HANDLER <10,000 CFM • NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = X1.00 = x 12.00 = x20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x20.00 = x25.00= x35.00 = 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 = x50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = 1 /o. co , a SUBTOTAL $ to . Do PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ -j.8D Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675