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1994, 05-24 Permit App: 94004687 Furnace, ACt-5org, x0512 MECHANICAL PERMIT APPLICATION FORM \fit s lnforrrztion Worksheet JOB STREET ADDRESS`S "t o 3 E Nvrzti CITY/STATE/ZIP: SIA. --L„, . 9t5 / 5 PARCEL NUMBER: OWNER:9 /Lyric a Ain-yPi' 7 PHONE NUMBER: 7„9..w -% C) 2 MAILING ADDRESS: / / (Street) (City/State) , / /� (Zip) CONTRACTOR: lV rn-rn hi zu .r, LICENSE NUMBER:/tt �ORCO CT 4 0 7 I L 0 / PHONE NUMBER: 5Z-9- y/ j S MAILING ADDRESS: 16 S /o 3 -TM-, ± S/1 A2-1, a_--, Y9„9 /°_ (Street) /City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) W000STOVE/INSEa GAS WATER HEATER GAS EQUIPMENT <100,000'STU:(INCLUDES::' GAS EQUIPMENT+100,000 STU DUCTWORK) GAS PIPING (EA OUTLET) BOILER/REFRIG 1-100M BTU :BOILER/REFRIG101400M 07th,; _ . BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG .1,0001 -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:1530 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 Nor COVERED ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANCE _>400,000 BTU USED APPLIANCE <400,000 BTU USED APPLIANCE ›400,000BTU, AIR HANDLER <10,000 CFM AIR HANDLER >10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE (o_/eGw- NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x12.00- / //.,n x 15.00 = x 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x60.00 = x12.00 = 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 50.60 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = / / j.G7 SUBTOTAL $ P.t/, o o PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ -99.00 Spokane County Division of Buildings West 131 'way Avenue Spokane, WA 99260 (509) 456-3675