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1992, 03-19 Permit App: 92001695 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS:99 CITY/STATE/ZIP: G/Do get. v-‹ OWNER: 6 %mock' ,r S ty MAILING ADDRESS: 361,0999 1� j 1leY Zt1�41-y _ . % 9a / 2- PARCEL NUMBER: Q 6 55/3 - g/O g PHONE NUMBER: 02 l - S-.2 6 d S/1-0 /6,-.4 'S'2/Z /� (Street) /% (City/State) p /► (Zip) CONTRACTOR:"D r( (Z 5 Sep, yr e,o f / dct LICENSE NUMBER: Ili 53 j (, ) �'!<' n r / 1 f)PHONE NUMBER: /(/ MAILING ADDRESS: /l PA^ KJ ° 5,6 . tA-4_ (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER :;+e+fn�?:::a:: w.>...a::► s::►;? frx�v�r #r:x: GAS EQUIPMENT +100,000 BTU DUCTWORK) i`.. AS Pt ING• TFl :.j:.4,',•: ;4:�v,:•4 ?irf l%i isiii:'t?':fvi4::i::i}:.>.r::.'r:.fv, BOILER/REFRIG 1-100M BTU : ::: ( :1..::101:- .+.kOR BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG +1,750M BTU F.; HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS VENTILATING FANS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG }:#.he;MM�f.: 4::7:3::Sii?/.•!1/.•i4:4!T.r,.:{.t..... }!R!RM+.T..R. �., ::...:.::::::.. :.:....... :::.:::::::::nom::.:::::::::. UNLISTED GAS APPLIANCE <40-:0,000 BTU ................... . ...................... USED APPLIANCE <400,000 BTU AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE 2 (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x25.00 = x 10.00 = x 12.00 = x 15.00 = x 1.00 is x 12.00 = x 20.00 _ x25.00 = x35.00= x60.00 = x 12.00 = x20.00 = x 25.00 - x 35.00 = x 60.00 = x 10.00 = x 10.00 _ x50.00 = x 10.00 = x10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = x50.00 = x100.00 = x 12.00 = x 15.00 = o( -D 7 c-7). de) SUBTOTAL $ 5Icro PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ Ar, dle Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 76