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1992, 11-06 Permit App: 92009841 Furnace, Piping MECHANICAL PERMIT APPLICATION FORM InformatiTn Worksheet • JOB STREET ADDRESS: U �) CITY/STATE/ZIPk -1(R`A C1Cial PARCEL NUMBER: OWNER: 1-3__D (1Aaan PHONE NUMBER: 9Q4 r (A-Q MAILING ADDRESS: (Street) r (City/State) ,` (Zip) • CONTRACTOR: 1 r A) 1�l Q `'k 1`.14 ,-1r'cICESE NUMBER: rl?. l-11t �1 PHONE� NUMBER: n MAILING ADDRESS: 1' ��5� �5 t �L u\ i l /`?i -CO I (Street) (Cfty/State .- (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = • p: .l. : ' ii E m X' x 25.00 = GAS WATER HEATER ��yy x 10.00 = • <. ' ; . Toa '4 8 8 A h'. 5 c{ . v.:} x 12.00 = CC) GAS EQUIPMENT+100,000 BTU DUCTWORK). x 15.00 _ t:.:, • ••a $ {:> • 'x.1.00 = .y , V� t BOILER/REFRIG 1-.100M BTU x.12.00 _ • x 20.00.= BOILER/REFRIG 501-1,000M BTU • x'25.00 = • ' • ts:.01 LirT1477. ..,a 1 g., ; 4 :. <af., x 35.00,_' BOILER/REFRIG+1,750M BTU .' x 60.00 = • ' xCff. z,V V.' ..S1 ga � ME& x 12.00 = HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 (:25:00 HEAT PUMP.&AIR CONDITIONER 30-50 TONS • x 35:00:_ x • .�' r) I ` (i ® 9 � e. � ; x 60.00 ft. r. VENTILATING FANS x 10.00 = ?"Q ')>..': ,' ,• • see. �•, � ,.�.Sk.+?4.'' .. .�:�.� •fi�+'.'J.v,�•;>»�+s�`.i:1�?...z �vv v i<�{r'�x.�+.i�f . - -.' � -x10.00 �. ::' - TYPE I HOOD(PER 12' OR.12':PTN.'OF HOOD) .x 50.00 = ' ���:�� ,��w.: �•�•�':.���#',s.�. a?�`xx`�����a•3�\,� .,r,;�>�;f�����;€��': X10.00 = •. • CLOTHES DRYER :x10.00 yry` fr x� ,roh' h rJ +fy } , fi:ri• ,ir:: ,�.�.�? �:. 1 ' };��� ��` •.�'�? ��r�� �; '�„��,��._ x 10.00 •_ . GAS LOG"• x 10.00 -:# Off.} g ' �< {° Po _ <;�..w � �< ���:��� . . -x 10.00 UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = : T C t:i.` # , ' t . t.., 4 ; x100.00= USED APPLIANCE<400,000 BTU • x 50.00 = �:J}vroyxxxrrf...vrrrvr�:{rr.ryirrrw H/ff^Yr MM(rrr r"C!4F+R}•£rt, A^+l.::H..j�^II�I�^.Y.r ,5 P' IANC• K MATte € :.` i x100.00= AIR HANDLER<10,000 CFM x 12.00 r,.•scy.,o,�ca,,y t '.3•.ar.:..a•...�3;.:{#•+;w•:yrx. x..�..w.•r. .Yh{�`;a{;�`Y4 �iy�f�� �;Y�.•�a.L,...;��r�.;{.Ms Egitit ANbf. E v (iTORT Gt� fY 4 GE��ri � Y ,< 4 x 15.00 _ hfAv: {::vh•:.. .a:...nr...:.vn}mvr.:'\•irkr:x:..n 'vvaaaaaaahm.xx1vv..�Cav:ivvm'w7vh.A•.i4.a�xa4xv., SUBTOTAL $ ) PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT FEE DUE =$ 6R,C SIGNATURE Spokane County Division of Buildings • West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675