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1992, 11-18 Permit App: 92010146 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: S J/ Pi e_r-c-e_ p CITY/STATE/ZIP: EQh rwA 1 r PARCEL NUMBER: PHONE NUMBER: Sp ak 2tJ� (City/State) LICENSE NUMBER: PHONE NUMBER: 9144 OWNER: l�A MAILING ADDRESS: 5. )16.1.-1 r c (Street) CONTRACTOR: Vt'/f4 MAILING ADDRESS: ✓u/ c7 ) .a L (Zip) (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) ::::....... ............:...:............. GAS WATER HEATER GAS EQUIPMENT +100,000 BTU DUCTWORK) •^::.v':r. v<.•:c:a}z;;,t4se,;::::.>.::::{::::.::•:rov{,:•:4.ww•{:::...:y:..y:...,.:... AS :4X.:4::•}:v:}}.}}}:4%•}:•:4:•:i•}:4}}} :•.{i..n... r....v.::?}}.:•{:•:•4{{ii? BOILER/REFRIG 1-100M BTU •:BOLEW ETi: :3/!:< 140.0 BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG +1,750M BTU 1✓ONQITI3NERSTQ[fi HEAT PUMP & AIR CONDITIONER 3-15 TONS tclJ�l1#;i:lk7t`'• HEAT PUMP & AIR CONDITIONER 30-50 TONS VENTILATING FANS :IONEB::+5t •;T• . { ... :..... .: .. ...................;..-........::::::::::::::.::...v::::::v :}}.::v:•:}}:v; TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG r''..............t3}?i?;n:..w..:.w,.�f:i. UNLISTED GAS APPLIANCE <400,000 BTU .::: }....}::{••. �:::{v•}::}}::::..::::iii:::::}:': �..:':..•}:}}i �..: ..:::: �:::::....... USED APPLIANCE <400,000 BTU 'ak:aff'Ia`i`i A i!Yic:K:iti:;EC}':.'i�iliw'rii::r.:•r.::;r::; AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE 1� (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = 1.000 = x12.00= x 15.00 = X 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = 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 = x10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x50.00 = - _ �l1 o� K / / • 0-0 r 2, W • x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ D-5. tro PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ So,'r° Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675