1993, 05-03 Permit App: 93003122 Insert 93r- .31 � a
• MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: A /V, S ' a • l " . 4+
CITY/STATE/ZIP: ����kctn•p. ( / , `1Ydd� PARCEL NUMBER:
OWNER: 11/e sslv PHONE NUMBER: Gr,. . `r c.;r),20 w -36'J
MAILING ADDRESS: 1 I t li S •'
(Street) _Ty,� (City/State) gip)
CONTRACTOR: 9`'� ��u � ' C LICENSE NULai PV( MBER: 7-C> f( 4 C_ S / 6�1�(
PHO E NUMBER: � -3 S - a
MAILING ADDRESS: 13 O? 5 `I 7 Dklfsw.� c ( c?-0 7✓� , �, r
(Street)'�" I(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE I oP14Ac I8( n1 G"
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = -
-
ika $TQ24 •J { f n ?fi :vx 25.00 = S O
GAS WATER HEATER _ x 10.00 =
:�. }. .}. ?�. �. :r., - f max;:..
B. 1* II.M f =
�::,,��.:j ,�,} rr}�,,.��� 'H}�;` '�v:;�� k:��}r.� }.::;}.:. r� x 12.00
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
' '„i- 'X11 1.0 I „x;''° '. .s.MENEREktrfAillinat x 1.00
BOILER/REFRIG 1-100M BTU x 12.00 =
01 . : t . Cl „„t . :_. 'v>?} :}' I:, .::<:: x 20.00
BOILER/REFRIG 501-1,000M BTU_ x 25.00 =
(Odli ,fr: v f?fi'F.yv:?:MY$+',' .}•:{?ti titer
t �k "�` x 35.00
.»fiCh f} vn8.. vCv�i'G,vA{vnY.•:rA:v h:::.\' •'k'{�ti
BOILER/REFRIG +1,750M BTU x 60.00 =
, ,,:' .K+i .' `t :U R... 7..:.'40aaa g x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
?cam,•.,,a. ...,� « %c:
t„ ; 7.: 7: �� . . o •'; x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
p..>,::.:rr,rwv:.,.:,.}•::rr::,.•?:,,: a w ,. vr::?,...r f. �?o:;rr
zE ' „ ANKOM . :: ;1 11 : 4 , ,. ;w�= x 60.00 =
VENTILATING FANS x 10.00 =
{: }� x Fc:r „may, f /f% i� ";ji6¢:: �':<::}Y"•" �'"}:"•:,
CAP 3.1 t 0,i:xME N Z: 4: x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
<. A '- 1 x 10.00
CLOTHES DRYER x 10.00 =
,F:.:•:::,:.,y:::.::f• :fiJt?,h} f ry }�;�r';'.,.,?�.•�1�/fo::i*o}•r..;:r} :::.>
BA1:G ESSI iv IENE.. }' x 10.00 _
GAS LOG x 10.00 =
R _ ?1, lr0 r. St V:k a ; . ,{ x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
rot 11�1ST l 140;,.,rI` .#)£# . ` ;1 ; 5<> ::r.:. ?»::>; x100.00=
}r.,.:.�.,:.,..,.r:.«,�.?,,,,-,vt:r:::r:.::.rw:.w,z'3,,��-,�,�,�,� t;�ww,,,.�.•.wt'^•}.N..�. ..,...,.r..::..w...,.::..:: .,,.. :.b' �.�rfr..:.,.
USED APPLIANCE<400,000 BTU x 50.00 =
.. ,...,yfr•:•}},}.:.r:a :.},�x;:r. fr{ 'u-:,4•s,,.N,.?rr.,{r:?•:,}:};}}}:.::::• :{.f::.:�+f£f[x'�f..}••}
':•':'f:w. �D /1 .,'fi^`a'•. .S .}}Q:t:}i,.••:•r.?•;:Sf?``<.`•::iS{:.•"?t•.,..} },s••:':r:::i:
C�y.Y+(j}: f: ;. vx,:: nr,. ,};:?::f• ;�:::' x100.00=
:i�.K!•.T..'.?A��+''�1. �'7� �.r:�f�7�7�.v �}iY'{�G:...........n.v..:......r...?i:°•fi�.f�. ".:
AIR HANDLER<10,000 CFM x 12.00 =
:,::,.::.;x•?.y}..},::.�;.:r},:,•.::..}::;.'fi••""}�,:a••:uq.•.w.,,,.•.,,..:}., �,{• ��;r..A,:ti:i'::: ':2:,`:t:`:i:::%;:rl.^c,,c:u%�`•'
AtI At�I niff e ;� P f.}}E $ . ?v� >:> >;>{'}x �.;.I x 15.00 =
SUBTOTAL $ a6,0O
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT
FEE DUE _$ -5-0 06
SIGNATURE ç127YLui'
Spokane County Division of Buildings