1991, 06-20 Permit App: 91003491 Mechanical Fixtures< 3 W -i i i;' f4 2J IP L 64A -U 1N.Ri maim VL t -b fe -
I a :orx;ation Worksheet
3OB STREET ADDRESS: -.5 (// y S1 SUN 4ow /
0/Liza
L
CITY/STATE/ZIP: Ane (,,)p+ . yQ2Q(O PARCEL NUMBER: B 6 S0 S
OWNER: At /107-1-145f4/
MAT
s;;,LTNG ADDRESS : S • Yl N $ S✓ n
(Street)
CONTRACTOR: /4/1C eSon5 6111e7 / 1t7 i
PHONE NUMBER: 9D7 -,V3.5-9
(DijenA-L- (JA- qqZ%%e
(C ty/State) (Zip)
LICENSE NUMBER: AA/h4 / i )3!$ 4/4,
PHONE NUMBER:
MAILING ADDRESS: /3 9b3 "1"12VA1- AVE.
(Street
4oim,.._ wA. 9q�11.
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT
DUCTWORK SYSTEM,
WOODSTOVE/INSERT-
-GAS WATER HEATER _ _ _
HEATING EQUIPMENT<10,0
00
',.HEATING EQUIPMENT +100,000
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C
.REFRIG 101-500M BTU
REFRIG 501-1,000M BTU_ _
REFRIG 1,001-1,750M BTU_
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
EVAPORATIVE COOLERS
TYPE T HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
BTU
BTU
OR ,. HEAT "SUMP)
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
.UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU_ _
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,0.00 CFM
,AIR.' HANDLER' >10, 000 CFM
NOTE: MINIMUM PERMIT FEE IS $35,00
SIGNATURE E2/C: /', 4 Vij&' S:w
1
.S
•
SUBTOTAL
= AMOUNT
x$? 0.00 =
x 25.00
x x.0.00 =
x 12.00
x :15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00' =
x 12.00 =
x 15.00 =
PLUS: PROCESSING FEE
/0,00
$ 27. oo
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
I= $ $2, op
Spokane County Department of Building and Safety
West 1303 B�•oadwav Avenue Spokane, WA 99260 (509) 456-3675