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1993, 04-28 Permit App: 93003004 Pool Heater MECHANICAL PERMIT APPLICATION FORM Information Worksheet c� JOB STREET ADDR SS: ..:7 / � CITY/STATE/ZIP: :i• - 7/4 PARCEL NUMBER: OWNER: vill-4 vc.c-- q 6'U`�K. PHONE NUMBER: / 2. MAILING ADDRESS: 4 "3+.i � q Street) (City/State) (Zip) CONTRACTOR: -ei-A °a✓�.�..( LA- 'iL LICENSE NUMBER: V/7 E ' & S U 1 1 �` Q PHONE NUMBER: MAILING ADDRESS: Z- ?5 6. P Mid- �'S4 (Street) . (City/State) (rip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = .v.}w:x:4.:v v:V•}v{rnv.,,,:•.:,y' :•:'� •+(} v:..3:ffiYS{y;.;%r,��y: ��.}x•4�:�;: �:SN.:QC1 #. ± gt ' ' : ',}. ';�. w : : .;::< .<;.: 4:;;;:<�; X 25.00 = x.4::x.•.vxvxvr.•.v:n,A„+v.•A.t40.u,i„•nsC4wTr]G�xfi}.v:.{•}.::i?`4�++`•.�L�i•:•.,�.,•.v.:......vn:r:.rw..,•..nvAn,,,xv:.,, GAS WATER HEATER x 10.00 = •'4••4.:. T. '�• ?. Yr:rr}^.•:.w:.v,%:f:}}iM`ev}?i'y a. �} 11 aN ,,,IL l „ :. s r:.Y x 12.00 = .GAS EQUIPMENT+100,000 BTU DUG-14610R14)-- x 15.00 = /51 00 i :{nv:+n,:r{...v..,.:.;x v.}r xx tl.:v:xa;,::v V•:GY .v.•.v M`}-."•Y.. tr": .? <" h ' .� 4 x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = ff W^^Y•U••}'r^�fr ,.2.•, }• f TxvM•:4•.. •y':.}l r•,, y FANKI iN I'nfr10: i?h4 ` r';<ant X 20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = fx {_:: ` «? : : ;' x 35.00 AMA N :£.Lim i _ :h,„,.4 .,,.•J..rS},f�� ..r•� •',4�hdN��:4.w,�ac':• :4:••.t' BOILER/REFRIG_ +1,750M BTU x 60.00 = ''f' K ? • ;I }..' � { : E rd <:ifi= x 12.00 = �r����� ix::�,.4:,ra�,^�'�w,rzc.,a,'.k 5'��?iwra;� w� ,t.4: HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 = '' Ir . '•;I" . .ffi' KE: t:.0:. x 25.00 = HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = px:.w:x:x:{rxx:m�:r:rf,4x �r 4r4• vtm::x: :{ ••�: vVf.�%{4IX44 ODIC .I> . f I .`r 1'fftdra :. x 60.00 = VENTILATING FANS x 10.00 = � 4f.Yr^}Yxr:^'Vr xrrr �, .,.{..�� ,.:�r°� ;� x 10.00 = #i31k fes: ' , ... TYPE I HOOD_(PER 12' OR 12' PTN. OF HOOD) x 50.00 = 4w::, :.;,.ICKI,'. r.:}ic r, .?'S`fi-.`'-::.:h r„ ;. +o-:24,'•�} .••k::k. X 10.00 CLOTHES DRYER x 10.00 = 4 �.•{r.}tv:•ti <}v �{ ^it:.;;•{:4:xCFv v.. ,4:5 :4 x 10.00 = GAS LOG x 10.00 = EI , f « .Vlgt3 ICER: ` x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ^}iW'Y:,+F.wrrx y:• x ^�^nf•r { N•:'J.: ,::,Y. 4)t*I:I?f; IONN: I:N ; ..,. . Q {..':.':.: :.: :k 'x:''?;a x100.00= 3h,: xx.,:wf.,•xfh.,r:,<•.•.,.:,G,•.,f3Xd ,a.:x''•.•T..••.:,�,o-Xxw.u.,•�r.:.,vvx:xlv.4::;'•:.4•hx4•.v:h:4::x:,�f.�.•.:,•. USED APPLIANCE<400,000 BTU x 50.00 = }?::.•: .:±•{i'.v xx.:;,'�i.}rV:?x..ffrry.:V{.:4•:r ::^Y4{, f(ffi•4n,..}}'f.•;; •::x•::�v:;,V•V!:}S;}i E� yN.'�-O?.':..xx1, yµyLO Y,>:�w}nr fri ;:` .u<;:<' x100.00= •'N.�4e.Y:v.���?R����hT:�+!+�T•Y��•�k���•� :��fr'+��•.•.'v.''.�x.:::Y_:. Yv:}}::v:::: .. v.i.:.... h•::•vn+rh4}k• rr.Rv•l.4 .. }• .... .:v`}}}f:�,+.:4:24::41:•.}f�:/r.':i.'{^ AIR HANDLER<10,000 CFM x 12.00 = 4}•.,.,:, 4;}•:'.r,}::., .:,yT,.;�S.;,r`^y4".t^x",p}•.,,;,v:.:Y`ifi '.k."..••}�,::`:,?X �:'.^.':}y';Yt`}•�;s`.'•''.,':`,}`.;yeti,r:`.'". ,}�(I Af'!mo too ' of J}+fvf,.:}:,+.{{{.}}}};x:44 $4>;r}'h; 4 f•4 $4 x 15.00 = , ,..,......}:h•::vv}:•:::} .....,:.:,:..:..rxrr h•..4r..:.vr...v4.x4..:.,.,.f�,,.:,444}:4}}}}:.w}}}}}.•.••:,:...tw:..t; SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT o FEE DUE =$ 3 SIGNATURE A-a/v€. IiI Spokane County Division of Buildings