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1991, 10-08 Permit App: 91006624 Insert
MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: ii.).SJdfl5 CITY/STATE/ZIP: b2/ PARCEL NUMBER: 35-6 43 - / to 03 OWNER: ( U;&1L. .t e4 v �� PHONE NUMBER: 9 -7� 75 MAILING ADDRESS: 4)_il�r. , ��S ecV .'S k,\Ar (.,3.x.5 I\ . %!z/C� (Street) (City/Sate) (Zip) CONTRACTOR: � M LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = WCODSTOVE/INSERT :> ::::; / x 25.00 = GAS WATER HEATER x 10.00 = GAS EQUIPMENT<100, OTU o-qp;opg• Egimmi.m x 12.00 = . GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = ............................................................................................................................................ x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = Bt ILF IRI*FF G:':1:01 I1fi.B'1'1 ;. . x 20.00 = ............................................................................................................................................ BOILER/REFRIG 501-1,000M BTU x 25.00 = EQILI /I`3I=p < :11.. 1,750M BTU' x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = HEAT PUMp` AIR CONDITIONER:0-3` ONS x 12.00 = HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 = HEAT .titRAAR' iTNEitl$4W...o...s.... .... _..... x 25.00 = HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = ifigArrUMittAgitgoNpyratg8,14$010N5Egiliiiiiiiiii$1 x 60.00 = VENTILATING FANS x 10.00 = x1 10.00 = TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 = ........................................................................................................................................... x 10.00 = ............................................................................................................................................ CLOTHES DRYER x 10.00 = ........................................................................................................................................... ............................................................................................................................................ IAN: x 10.00 = GASL�::::::::......................................................................................... ........... x 10.00 = .....ASLO...................................................................................................................... ........................................................................................................................................... MISCECEOUS(NOT COVElRED ELSEWHERE x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = UC INSTED A`S APPLIANC :>400;t BT .::><;::::: :_:::. ,:.:: x100.00= USED APPLIANCE<400,000 BTU x 50.00 = ............................................................................................................................................ USEt APPLIANCE F Q 6I U: x100.00= AIR HANDLER<10,000 CFM x 12.00 = x 15.00 = SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS • - .00 EQUALS: TOTAL PERMIT 4 f FEE DUE =$ SIGNATURE . 1 t sokan• County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675