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1992, 10-14 Permit App: 92008857 Mechanical Fixturesc2_ 8857 MECHANICAL PERMIT APPLICATION FORM (.-1- . Information Worksheet . JOB STREET ADDRESS: • A��_ C� r C9- L� �ti1�!e% C�� - CITY/STATE/ZIP: J\.( , \ _C\ C I� PARCEL NUMBER: OWNER kS , \c�Q.-s C\_..: "---- PHONE NUMBER: CA. Ls2 " CC \ MAILING ADDRESS: \ (Stree (City/State) CONTRACTO .c)N\!''�V S,, C \-0“\Q LICENSE NUMBE': ` \A' PHONE NUMBER: \r -VAS - C-- MAILING ADDRESS: ` . (---\\76-2 :c) k.L., kc--->\10:\C� A.f\l t`' \ , v \C\ :--� S (Street) (City/State) ' (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE (Zip) Cca- DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/INSER•T GAS WATER HEATER GAS EQUIPMENT <100,000 DTU (INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING (EA OUTLET) ;° BOILER/REFRIG 1-100M BTU BOILER/REFRIG 501-1,000M BTU BOI.LER/REFF IG 1,0001 1,750M RTU........ BOILER/REFRIG +1,750M BTU HEAT PUMP &. AIR..CONDIT.IONER: O 3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PU,MP..&: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 ULLNSTED GAS; APPLIANCE_;>400 000 BTU USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 ;BTU AIR HANDLER <10,000 CFM AIR HANDLER >i 0,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 \) , SIGNATURE�+C Spokane County Division of Buildings NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00 = x 10.00 = x12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 = x 25.00 = x35.00 = x60.00 = x 12.00 = x 20.00 = x25.00 = 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 = \C„ ,CC 1 . GO SUBTOTAL $ , PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ ,C)