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1992, 09-18 Permit App: 92007843 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM 9 gc_i3 Information Worksheet JOB STREET ADDRESS: L 55 33 s‘-;I:ovN CITY/STATE/ZIP: (-71-Np‘, toctr •lP10% \111- qcto PARCEL NUMBER: OWNER: -AA-4.e MAILING ADDRESS: 23 N\(‘‘ (Street) (City/State) (Zip) CONTRACTOR: 1‘‘..n-c‘c.Vi \tkv_stIrt+., LICENSE NUMBER: tK\.6X2.1-k C-Vrto C:c - PHONE NUMBER: 3 S sa3 PHONE NUMBER: ciii0Q7 MAILING ADDRESS: 1C), 3 E7 -1N4 111c -q_ DESCRIPTION (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQUIPMENT <100,000 BTU (INCLUDES GAS S EQUIPMENT +100,000 BTU DUCTWORK) :." BOILER/REFRIG 1-100M BTU. ii".30K0401.00110.1ii141400.4iir: •:. BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,0001-1 ,750M BTU BOILER/REFRIG +1,750ivi BTU 1100PIAlt!$Afft100140)110NOtt04JTONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR CONDITIONER 15-30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS 11:00.0#041klAik'006.00006)00140t.7:.11:::::.1 VENTILATING FANS EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE II HOOD +CLOTHES DRYER RANGE GAS LOG MISCELLANEOUS NOOPYgOWg0gMig::" UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPUANCE >400,000 BTU USED APPLIANCE <400,000 BTU •,•fi'SEI:i•APPLIANCt.5•4601)OtYtt.7":::•••••""""--...-"•••• AIR HANDLER <10,000 CFM AIR HANDLER >10,000CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = 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 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x10.00 = x10.00 = x 50.00 = x10.00 = x10.00 = x10.00 = x10.00 = x10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = /b •00 [67.00 Ai .OD SUBTOTAL $ Plo-oc) PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ SI.00 Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675