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1994, 07-22 Permit App: 94006920 AC MECHANICAL PERMIT APPLICATION FORM C4' lo qZ-0 Information Worksheet JOB STREET ADDRESS: s, o o I, �_.„Q.,-z,„ cr ti CITY/STATE/ZIP: S �v /1, PARCEL NUMBER: OWNER: y-r2� 1�O�i aM PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: I)) (- -c /J. t-i LICENSE NUMBER: i PHONE NUMBER: 5 'i 419 7 5 MAILING ADDRESS: 3 _� b_2 9 f / (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 QUIPMENT 100 0001 TU(INCLUDES x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = x 1,00 = BOILER/REFRIG 1-100M BTU x 12.00 = BQILER/REPRIG 101 '500M 7U...... !: x 20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = BOILERIR FRIG;; ,000 -1,75 M BTU x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = HEAT PUMP!I<`AIR CONDITIONER 0-3 TONS / x 12.00 = HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 = NEAT PUMP AIR CONDITIONER 15-30 TONS x 25.00 = HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 = HEAT PUMP&AIR CONDITIONER +50 TONS x 60.00 = VENTILATING FANS x 10.00 = EVAPORATIVE COOLERS x 10.00 = TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = TYPE II HOOD - x 10.00 = CLOTHES DRYER x 10.00 = RANGE x 10.00 = GAS LOG x 10.00 = MISCELLANEOUS(NOT COVERED ELSEWHERE'- x 1,0.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.1)0 = ULINSTED.GAS APPLIANCE>400,000 BTU x100.00 = USED APPLIANCE<400,000 BTU x 50.00 = USED APPLIANCE>400,000,BTU x100.00 = AIR HANDLER <10,000 CFM x 12.00 = AIR HANDLER>10,000`CFM x 15.00 = SUBTOTAL $ )S. Oo PLUS: PROCESSING FEE + $ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE = $437, 00 / i SIGNATURE i � /J / Spokane County Division of Buildings West 131 'way Avenue Spokane, WA 99260 (509) 456-3675