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1992, 12-02 Permit App: 92010562 Mechanical Fixtures MECHANICAL`PERMIT APPLICATION FORM 0\,(2._ - I c52 Information Workshe t . D-11-1 �1� ? I JOB STREET ADDRESS: , ti )6 (t; frtt-�/Y1(%CIs?i C/k CITY/STATE/ZIP: \--47:), GU1 %'2()(Q CJ PARCEL NUMBER: C r OWNER: � ' .r/77 I�� PHONE NUMBER: ,S Z -/,� MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: ; 7 (/) *,;6)4:4.21 LICENSE NUMBER:k COHR/76/CZ- P NE NUMBER:,53`f//2 MAILING ADDRESS: 1, j/e) 3 7/11 l-. /JJI Qiy/- (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = w x2 = Div : " 5 00 GAS WATER HEATER:::::::.................................................. .............. .. x 10.00 = : ............................................................................ Itqui GAS EQUIPtMENT .100,000. TU INCLUDE .` ::`': x 12.00 = /,2. a.% GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = �- GA&P1PiNG( OUTL�1�.......>;:>:»:<:::::<: ;:>:::>.;: : ;:;:::;:::<: :::>:;::::;:::::::, =x 1.00 /. a BOILER/REFRIG 1-100M BTU x 12.00 = B IL >'1=1=:1 a .> Int 8 x 20.00 = ::. .. ....................................... BOILER/REFRIG 501-1,000M BTU:::::::............................................. x 25.00 = ....................................... BQI;LER/REFRIG 1,0001 .1,750M BTU.........:: . x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = HEAT PUMP&AIR CONDITIONER.:O $TONS ; �. x 12.00 = /02, CSL HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 = HEAT.PUMP&AIR CONDITIONER;15 S0 TONS ;:•` >< :: x 25.00 = HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 = HEAT PUMP&AIR ONDITIONER +5d TONS; ;; x 60.00 = VENTILATING FANS x 10.00 = EVAPORATIVE COOLERS.... .. .. >.>s;:';;.:> x 10.00 = TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = x10.00 = gip : .f..H.::< .>_' >«»><�>�< ><g< < «<> «<<> <>> > <<> ><><>>` < • CLOTHES DRYERx 10.00 = ........... ... . ..... x 10.00 = GAS LOG x 10.00 = MISCELLANEOUS(NOT COVERED ELSEWHERE;;.:: :: x 1.0.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GAG APPLIANCE 5400,000 BTU: '` x100.00 - USED APPLIANCE<400,000 BTU x 50.00 = USED APPLIANCE>400,000;BTU > :::':::` : ; ` ' x100.00 = AIR HANDLER<10,000 CFM x 12.00 = AIR HANDLER>101000 CPM : . x 15.00 = SUBTOTAL $ ,-)95, eta PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT 1 5Z). � 1 FEE DUE = $ .SU. SIGNATURE ( , az-,,.--- i\--)/1---61- Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675