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1994, 07-22 Permit App: 94006892 ACJOB STREET ADDRESS: CITY/STATE/ZIP • ` PARCEL NUMBER: OWNER: 9..p. �l�-Y`-ems .' PHONE NUMBER: 7 '1- 7 6, MAILING ADD SS: / (Street) , . (City/State) / / (Zip) CONTRACTOR: A)4-,�-- iJ p,i --t-L-1,-1 LICENSE NUMBER: l'\) /) /,'/ ' Ca i 01 4 4, of MECHANICAL PERMIT APPLICATION FORM Information Worksheet 5 qq-coFs9a i PHONE NUMBER: 53.c%- ).J9 ) MAILING ADDRESS: (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/INSERT GAS WATER HEATER GAS EQUIPMENT;<1001000 BTU (INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING (EA OUTL BOILER/REFRIG 1-100M BTU BOILER/REFRIG 101-500M OTU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,0001-1,750M BTU BOILER/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 TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE II HOOD CLOTHES DRYER RANGE. GAS LOG MISCELLANEOUS': (NOT COVERED ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANCE >400,000 BTU USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 BTU AIR HANDLER <10,000 CFM AIR HANDLER >10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00 = x 10.00 - x 12.00 = x 15.00 - x1.00 = x 12.00 = x 20.00 = x 25.00 = x35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x60.00 = x 10.00 = x 10.00 = x 50.00 = x10.00 = x 10.00 = x 10.00 = x 10.00 = x 1,0.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = / z , (j c x 15.00 = SUBTOTAL $10,00 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$.r/.00 SIGNATURE Spokane County Division of Buildings West 131 'way Avenue Spokane, WA 99260 (509) 456-3675