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1992, 01-10 Permit App: 92000193 Heater, Piping MECHANICAL PERMIT APPLICATION FORM LS CS (4.d ) Infgrmatidn Worksheet s / JQB.STREET ADDRESS: .. . - I CITY/STATE/ZIP: ��7 S ��1�Gry/`JI PARCEL NUMBER: OWNER: 70.4( G u/T'-s 5 9z.106PHONE NUMBER: "71) MAILING ADDRESS: Soihvi Aka✓2 (Street) (City/State) (Zip) CONTRACTOR: '( 7, /(?-5 LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: ,5Z7/44-e (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = x 25.00 = GAS WATER HEATER...:.;._.: :.-...:.. :. x 10.00 = gAggattgRtgin.0001041INOVONIENINE x 12.00 GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = GASP. P. =.FA<,U�.:> :<:}:<.i?:r-,.:::�•4�`''•-.°.�...}:-,.:_::_:><::z:>:::<>::<:>-<:>::<::::::_:<:>_::>::= x 1.00 =:::k?•}.v i�trr�A�:r. ......� :'{vfiYY.4:i•::i:vvirii?:r,+�{�'.�G::..:..:..............v..:....v..,...» BOILER/REFRIG 1-160M BTU x 12.00 = • iI� , iiiA::--- :_.Q. tBF1= 1G:....0...-�►#�tt -G :>vY:�:'�:<<�::~:-<><:>:>:-;ga=><``><:...'=-="< 000 BOILER/REFRIG 501-1,000M BTU _ x 25.00 = .xN,v.:vxuvv:nv�w::i.;xr:?:Y.:�;.iv}::{;>�{4:4:0}aYt xvvur�:lf x::i.yif:ir-?'-};.-}}w::.�4:?.-::>-}..::n:•>-y.;n:- 90.. < _; :: .i".. lu!_ :-n,;:?:i>:==r:>:=-}:.:>n-<<-::::::<w::<:;::�:;: x 35.00 BOILER/REFRIG+1,750M BTU x 60.00 = rr:.wv}•xn;.vx?i_yxf_x;y::::{r:- vnY`M-:vv,•rr:::vr.},y::xr{ixfir tR Ct'I►ND <: 1' :: _ x 12.00 = ,,a:a}:.w.�rA�.�-:r..�w;,-" -� HEAT PUMP&AIR CONDITIONER 3-15 TONS , .; _ x20.00 = #' i : i Rr 1� � ,1 ` x 25.00 HEAT PUMP&AIR CONDmONER 30-50.TONS- x 35.00 = • +7771 -A..1 -prx 7 r4{A•xv ^'G^M^rr. :fw .vw,^LC+r rC--yixix::::,:-r-•::::� x60.00 VENTILATING.FANS v -= x 1000 _, k tr7" yrs s ...' ks"r-"•' ac', {-'.-.----_-----}->-�--~.--},>->_------:, X a .1 _ . AA.iNrJ}rrx"avFriWW�3pvWwdw:i/nNihwrnv :: •r�' •N}_:Anv.,0Y3SriY�n¢n'i-- TYPE I HOOD(PER,12',OR 12'°PTN.OF HOOD) • x 50.00==• • - EalrwwWW. w ?yR :IOM E : » Mrx10.00 _ CLOTHES DRYER'.` x 10.00'. M?.<M $ri 'AM ` '-- .'. x 10.00 = GAS LOGx 10.00 = ,t _ I ::.: x 10.00 UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = f•:.� ,.�yy,^^}�:� }y.,:R:,•.•h x•.t#,w,y.�y�w„.•,y-^ nkF:,}:;:-�X?r�.�rY�,=. =: # PE = 'lxi}:;:::;..:i4}:x,.. . x100.00= fr:}.«w.�,a..;c,ac.,�,.�w.,i,M1 :.a}..• Sa.:' ,.,•,wn.Va.�;,.:� ..wax,..,•..,v.Az;,,:x:;::<::tdi;�.r.n-• USED APPLIANCE<400,000 BTU x 50.00 = ,,.r?rr?xxx,�r,.:>x x>�,.y,Yr4•?:.•?x::4Y�a:...{r:.ti.?xy.:;:,??::.�::-.-.r.;:,?.:;:,;},s-:;;t�u::a�:.:.;,_�,?<`}`V'�y `3:> SI : IPP A ICE)4 O am 3 �i 3 f; .. x100.00= .,..M..,�„•.,.,8.•s rxr:.vx..,..x,..:.,, s�,,.:.,,..:...x. :--r---x..�,:,�}.:r.. <f; �-�:; AIR HANDLER<10,000 CFMr.x :.. r. . x 12.00 = �:?.r..:.Yf'; r rv:),•'?nxw:4i}}:?4:ivH yny...yx%w.v:.::x.Y/.-�.�.:'i",'- r.{:riil._}}:${•'.t:.::-::.-iilii}{4{F'ii'iu� _ • .yxx-y, ____ _ i� .. :.:::•:it•}}}::•: X 15.00 SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 • NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT FEE DUE =$ SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675