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1993, 02-11 Permit App: 93000793 Gas Pipingl 111-.k D 0.1 AFTF ` / vwiic fir o�G -z, MECHANICAL PERMIT APPLICATION FORM J Information Worksheet JOB STREET ADDRESS: 1 4/ 00 L iv/ )L©iv CITY/STATE/ZIP: S/C>K/44UL- PARCEL NUMBER: OWNER: n 1`4 )v C...414 -USS C77: )'V PHONE NUMBER: MAILING ADDRESS: /4-314 tz CONTRACTOR: T N. 2E520UPRIVER • PAKONF WA. () (City/State) (Zip) LICENSE NUMBER: re----1-74,71)r-7/3'f % PHONE NUMBER: ' 3 0.i 7'/ MAILING ADDRESS: (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER ::::..:...:....:.....:::..:.....:...:....:::.....::.:...::.. ......:::............................................... GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG +1,750M BTU H T PUMP` A R CON I IONER -$ TONS:::::: HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS ♦:��:il.::l�%M:`%►��iti�lY�►•:.JAv::Y►Yi�:•:ilii:iK:tNIM��YiUk 'L'�:WYW2:i �:ii:'tii:�Mi1��Y:kI►:•::::•: .VENTILATING FANS TYPE I HOOD (PERI -2' OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG UNLISTED GAS APPLIANCE <400,000 BTU _��. ��'�.. Vis• ��� ��t.: �. USED APPLIANCE <400,000 BTU AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 x 10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x20.00 = 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 = x10.00 = x50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = C SUBTOTAL $ PLUS: PROCESSING FEE . + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675