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1993, 01-12 Permit App: 93000146 Mechanical Fixtures • MECHANICAL PERMIT APPLICATION FORM � �- < y � / ,-•--?,) Information Worksheet / JOB STREET ADDRESS: ,) CITY/STATE/ZIP 4 1 Are, 9 92e PARCEL NUMBER: OWNER: Eem PHONE NUMBER: 9°) `� 6 7e?� MAILING ADDRESS: (I � (Street) (City/State) (Zip) CONTRACTOR;! �4' t cat tit LICENSE NUMBER: A) � R&F 1( (v iD -1 '7 PHONE NUMBER: 9 - 4702 9 MAILING ADDRESS•v' /3 Lill 9 6Y 0--. , 3 (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 = GAS:EQUIPMEN '+c l OQ,000 BTU.(INCLUDES:::. / x 12.00 - /c.2.66 GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = GAS PIPING F..A t�U L x 1.00 = /,0 O .::::. ...:::::........... BOILER/REFRIG 1-100M BTU x 12.00 = FOIL R/AEFf G O OOM:ETU:.. x 20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = ......................................................................................................................................... x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = ti ►T FUME' AIR ONt ITIQN R 0- TONG x 12.00 = HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 = ;HEATPUMP&.AIR.CONDITIONER 15-30 TONS.... >:<:>` x 25.00 = HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = HEAXPUMP&AIR CONE il'ION R t 0 TOMS. x 60.00 = VENTILATING FANS x 10.00 = x 10.00 TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 = x 10.00 = CLOTHES DRYER x 10.00 = FANG x 10.00 = ................. ...... GAS LOG x 10.00 = .......................................................................................................................................... MMISC.ELLANEOUS;.(NOT COVERED ELSEWHERE . , x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 ULINSTED GAC APP .IMNC IQ0 000 ........... .. x100.00= USED APPLIANCE<400,000 BTU x 50.00 = USED APPI GE 00,0OO ST I:: x100.00 AIR HANDLER<10,000 CFM x 12.00 = nig HANDL . 10 CFM x 15.00 = SUBTOTAL $ /3 p(3 PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT D0 FEE DUE =$ IAA SIGNATURE . /Y 6- Spokane County Division of Buildings West 13n3 Rrnadwav AVAn11A SnnkanA_ WA 9926n (Fn91 456-3675