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1991, 08-15 Permit App: 91004754 MechanicalMECHANICAL PERMIT APPLICATION FORM e r Informat n Worksheet JOB STREET ADDRESS: CITY/STATE/ZIP NUMBER. I�S�� n5/6 OWNER:PHONE NUMBER: MAILING ADDRESS• (Street) -- (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: AMOUAHE193N1 r PHONE NUMBER: 928-2100 MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE DESCRIPTION SCHEDULE NUMBER OF UNITS X EACH UNIT = AMOUNT DUCTWORK SYSTEM _ _ _ _ _ WOODSTOVE/INSERT_ _ _ _ _ _ _ _ GAS'WATER HEATER_ _ _ _ -_ _ - _ _ HEATING EQUIPMENT <100,000 BTU - HEATING EQUIPMENT +100;000 BTU _ _ ;- GAS PIPING,(EA OUTLET) _ REFRIG�1-100M.BTU (NOT A/C.OR;HEAT PUMP), REFRIG 101-500M.BTU- _ _ _ _ _ REFRIG.501-11000M BTU' r' BT REFRIG 1,001-1,750M U_ - _ _ _ - - _ _ _ _ _ _ _. REFRIG +1,750M BTU.-' _ _ _ _ _ _ _ _ HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ HEAT PUMP & AIR CONDITIONER 3-15 TONS _ HEAT PUMP & AIR CONDITIONER 15-30 TONS _ HEAT PUMP & AIR CONDITIONER 30-50 TONS _ HEAT PUMP & AIR CONDITIONER +50 TONS _ VENTILATING FANS EVAPORATIVE COOLERS_ _ _ _ _ _ HOOD) TYPE I HOOD (PER 12' OR_ 12' PTH_. UF77H-065) 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 <16,000 CFM _ _ _ _ _ _ _ _ AIR HANDLER >10,000 CFM _ _ _ - _ _ _ _ x$10.00 = x 25.00 = x 10.00 = x 12.00.= x 15.00 x 1.00, - x 12.00::= x 20:00= x25.00 x 35.00- x.60.00 = x'12.00 x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 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 = -. 3' ( .[9D SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT NOTE:M MU P IT IS $35.00 FEE DUE _ $ 37, Q() SIGNATURE Spokane Coun#y Department of Building and Safely West 1303 Broadwav Avenue Spokane, WA 99260 (509) 456-3675