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1993, 03-26 Permit App: 93001867 ACMECHANICAL -PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: Th I 4e19 CITY/STATE/ZIP: OWNER: c • ?K -- \14 MAILING ADDRESS: CONTRACTOR: MAILING ADDRESS: PARCEL NUMBER: PHONE NUMBER: 3,2,) (Street) E. / 7c013 721' lk-r S (City/State) (Zip) LICENSE NUMBER: ei h i46I j * f3LL) PHONE NUMBER: /18'4- I4/QS Sicco9q ao7 DESCRIPTION (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQUIPMENT +100,000 BTU DUCTWORK) GS;PIP1C Cx > BOILER/REFRIG 1�-_100M BTU wi}.:a}::.:a.:s: ..qeer.,: BOILER/REFRIG 501-1,000M BTU sP ITT it#11+ i5• b`.#' a�i7�i Vit. ttlifi :,�$"'.�'�.. •.}iyt .�.'.'3 ,i BOILER/REFRIG +1,750M BTU t''f?UIN ,1I tit:: ` . HEAT PUMP & AIR CONDITIONER 3-15 TONS , .},. H"M}vvY.^vm 93:a+M•.,`^yyy:^! R z.4}�zc. za«z HEAT PUMP & AIR CONDITIONER 30-50 TONS Y: rrJ•r:: JWt.{r!:/i:r �r:f:.a::r:rrryr:rv!•w . yrrr.. •k K:L7:H. VENTILATING FANS .�v� �ii�ii�••Mi.4��0�6�A{n!Ic�'^• �4. � ,y �i� ��,}. ,}/f��{�, {ifY ,atv ,Nr TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) X,+. 0.��. air CLOTHES DRYER GAS LOG UNUSTED GAS APPUANCE <400,000 BTU r icy �'�;g�►yy�.yyQ.yf:.yv.•:�:y!�r�r�:••:t•.}J•:(::y/x�.•.fi•:. 'y:ad)/�.y/vyr/yj'w �� y;•;v^.hi`: S'•' ,4:i.Li.1±o✓; �x}hiNf1w.Fv Pj t 61.,t: G : v}:x�'wn s��� 1 av��•'ryk:i Zv i USED APPLIANCE <400,000 BTU u;:ymrr.wr •A: )Cv:r'w ••• W�v. aYU.* *:&.: }4\fXx93•' AIR HANDLER <10,000 CFM 'V::: i:• M p•E• K .; } :}:... ; ..}} };}}.:n:: •: ...;. vt u...: }:.:.;::: ry}:{}i{•:.\, •i}•::. }": i i C;ilr�i ��1I�Sl.V.,.V.�:;�Yf•;,'wirlSi3.�Y'.'•:f'.i.•'�..dSAeL}'�:Sfi':,•.: }�:: x•::o:J:}}.:r NOTE: MINIMUM PERMIT FEE IS $35.00 NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 = x 25.00 = x35.00 = x60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = ,T (), Oe..) SUBTOTAL $ c:Ck). 1) PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ L! ). ) SIGNATURE /oar Spokane County Division of Buildings `� West # Rrnadwav Avani is Rnnkana_ WA 9g2Rn (Rngl 4RR-"R7R %-yi' - ��L�