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1993, 01-19 Permit App: 93000259 Gas Log, Piping q ( a, ( ©`q L • �. °13- SQ/ p)-- -)MECHANICAL PERMIT APPLICATION FORM We((esc- MQ.na( Irtiormation Worksheet -I cn JOB STREET ADDRESS: M . q(D,2 ( 10) �u\-0( RO( • t coiq CITY/STATE/ZIP: <),IpOYF)hk I u( 113.2_ I t PARCEL NUMBER: OWNER: C IA oLi + PHONE NUMBER: J� 1 - Octiyg MAILING ADDRESS: ► (Street) (City/State) (Zip) CONTRACTOR: t" E < (`1 i}t D ;./ (E r.1 f r-r2 LICENSE NUMBER: c--4 I C.C% (1(2, I i. L 1-& PHONE NUMBER: (_`i(-r?) c7,2(---,c'`7 / I MAILING ADDRESS: C • �J 1 n :_-..).,')F71','-'10,1-1. . -`.t_,-'ii,, :_ ).:i.:;) c1 ' G(r. (Street) (City/State) (Tip) ._. MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION _ OF UNITS UNIT =AMOUNT LECTRIC/DUCTV./ORK(S PARATE SYSTEMS) I x 10.00 ti;OODSTOVE/INS R x 25.00 = GAS WATER HEATER x 10.00 = GAS;EQUIPMENT<100 000 3TU(INCLUD S x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 GAS•P1PIINNG•(EA OUTLET} 1 x 1.00 - ) ,v o BOILER/REFRIG 1-100M BTU x 12.00 = I SOIL=R/RF EnIG 701 500M BTS • x 20.00 BOILER/REFRIG 501-1,000M BTU _._ _._.......__ x25.00 = BOIL R/i3 FRIG # {30011 750M BTU; x 25.00 = . • - BOILER/REFRIG+1,750M BTU . .:'' ' ',------------ -- - x 60.00 = - . i3-PUMP c".Y AIR CONDI t IONER O-3 t ONS i x 12.00 =- I-1EAT riiJMP &AIR CONDITIONER 3-15 TONS -- .- x 20.00 Hf A,t: PUMP&AIR CONDITION. ER 1530 TONS x 25.00 = ...._.. .. ....... .:..:. ..-:. ......::-..„••::::_...c................... ... :. ...: » �. HEAT PUMP&AIR CONDITIONER 30-50 TONS - x 35.00 = .HEAT PUMP&AIR CONDITIONED +50 TONS x 60.00 = . VENTILATING FANS x 10.00 = 'EVAPORATIVE COOL:RS .II -- _ xt0.00 =T 'TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = 1 01FEIIHOOD . x10.00 = CLOTHES DRYER ( x 10.00 = PAN,J- = N GAS LOG ' x 10.00 = I e. , OD MISC LLANEOUS(NOT COVERED ELSEWHERE x 10.00 UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GAS APPLIANCE>400,000 BTU x100.00= L.__ USED APPLIANCE<400,000 BTU x 50.00 = USED APPLIANCE>400,000 BTU xi 00.00= AIR HANDLER <10,000 CFM x 12.00 = AIR HANDLER>10,000`CFM x 15.00 = `'`!SUBTOTAL _ S j(.Qb '-PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT FEE DUE =$ �(r --05 SIGNATURE Spokane County Division of Buildings