1993, 02-01 Permit App: 93000532 AC3cicV 0613
InformttiFt Worksheet
JOB STREET ADDRESS: S, Hoc) -7 (R j
CITY/STATE/ZIP: SRA -04+• tOr Z0(... PARCEL NUMBER:
OWNER:1 'X.e.Jj'40
MAILING ADDRESS: S041^40L,
(Street)
CONTRACTOR: 1 VCv
PHONE NUMBER:
(City/State) (Zip)
LICENSE NUMBER: b1 VC.o E1 ! F3$ L -G
PHONE NUMBEER,: S 34 - 722_5
`
(City/State) (Zip)
MAILING ADDRESS: J I 715 11/44 (,,14
(Street)
MECHANICAL WORtSHEkT/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT
AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100#000 BTU
HEATING EQUIPMENT +100,000 BTU
;GAS PIPING (1 - 4 OUTLETS)
G115 PIVING (5 on holm. EACH!)_ _ PAP)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER
BEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
VENTILATING FANS
EVAPohATIV> Coot. tt5`
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
I.- L. .... .L - - - -
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_ _
UNLISTED GAS APPLIANCE >400,000 BTU_
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
x$10.00 =
x 25.00 -
x 10.00 =
x 12.00
x 15.00 -
x 4.00
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 =
x 10.00
R 10.00 !!--
X
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
ZO
NOTE:
SIGNATURE,
E IN $35.00
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
+ $ 25.00
Spica a aunty bepartment at Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675