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1993, 06-15 Permit App: 93004582 Piping, Insert
MECHANICAL PERMIT APPLICATION FORM /3LI - Information Worksheet JOB STREET ADDRESS: 23 l� S, c)/e) �/l)Q� 1 ZGPI�UP ��0 CITY/STATE/ZIP: C -3th'�Ue O JQ PARCEL NUMBER: OWNER: j,PRe LL K '-°H-- PHONE NUMBER: 9,7e- /94._q MAILING ADDRESS: ad,//e. (S et) (City/State) (Zip) CONTRACTOR: 414(1)12/ 7Lote, L%SLICENSE NUMBER: Li&kid C/02( ,gym PHONE NUMBER: MAILING ADDRESS: F, (A Jo (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = WOODSTOVEIINSERT <;: ::' :::::. . :.... ..:...... . ..:::: x 25.00 = GAS WATER HEATER::::::.......................................................................... x 10.00 = ........................................................................................................................................... ............................................................................................................................................ GAS 1_QUIPMENT' 100,000`BTO (INCLUDES' x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = ........................................................................................................................................... x 1.00 = 6� BOILER/REFRIG 1-100M BTU x 12.00 = x 20.00 = • .. .. ... . ....... .. ........ .................. ....... .... ........................................................... ........................................................................................................................................... ............................................................................................................................................ BOILER/REFRIG 501-1,000M BTU x 25.00 = ............................................................................................................................................ BAILER/REFRIG ,0001 1 750M BTU x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = HEAT PUMP&<AIR CONDITIONER O .TONS:....::... ... x 12.00 = HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 = ........................................................................................................................................... ............................................................................................................................................ HEAT:PUM.P.B�;AIR;CONDITIONER:15 30:TONS..... x 25.00 = ..................... ....................... .. ....... .. .......... .................. .......... ...... ............................................................................................................................................ HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 = ............................................................................................................................................ ::HEAT:PUMP:&AIR CONDITIONER+50 TONS x 60.00 = ..... .......... ......... ........... .. ..... ..... ..... ..... . ...... ...... ........... ............ ............................................................................................................................................ VENTILATING FANS x 10.00 = ..........................................................:................................................................................ ........................................................................................................................................... TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = x 10.00 = CLOTHES DRYER x 10.00 = x 10.00 = GASLOG::.:::.............................................. ..... ....................................::::::::. x 10.00 = Q .: MISCELLANEOUS:(NOTCOVERED ELSEWHERE p_: / x 10.00 = 0.00 UNLISTED GAS APPLIANCE<400,004 BTU x 50.00 = ULINSTED GAS APPLIANCE>400,000 BTU x100.00 USED APPLIANCE<400,000 BTU x 50.00 - USED APPLIANCE 00,000 BTU x100.00 AIR HANDLER <10,000 CFM x 12.00 IN AIR HANDLER>10,000 CFM; x 15.00 IN SUBTOTAL $ 11100 PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTAL PERMIT FEE DUE =$ <36, (� SIGNATURE #/f/fi ,j' Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675