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1992, 10-29 Permit App: 92009486 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM . information Worksheet JOB STREET ADDRESS: S. 2 -i l 7 ;--11" C> 10 CITY/STATE/ZIP: SP D k W a 9'1 an (' PARCEL NUMBER: OWNER: g r 2vv_ P jc? +L PHONE NUMBER: q �8 -1//q MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: F ) C_i Ci R2ri-_nJ CF.jJJ F,2 LICENSE NUMBER: r4I CO C-4 C., i -73 1 L( PHONE NUMBER: ( C q3) MAILING ADDRESS: E. (131 C J+O ti E'. � AA) (Street) (City/State) DESCRIPTION Lv.3 Glt72 o(n (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOO©STOVEJINSR� GAS WATER HEATER GAS. EQUIPMENT<100000 BTU 4.I3QES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING (EA.OUTLET) . BOILER/REFRIG 1-100M BTU BOILER/REFRIG 101 00M :. BOILER/REFRIG 501-1,000M BTU BOILERIRI` RIG 1;0001 ;;1,7a0ti! BOILER/REFRIG +1,750M BTU HJT PUMP & AIR CONDITI NER 0-3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS -- HEAT PUMP & AIR CONDITIO•NER 7a0 T{NS HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT` PUMP & AIR CONDJTIONER +50 TONS VENTILATING FANS EVAPO RATIVE COOLEF TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE<1:..,.....::....:<' CLOTHES DRYER RANGE . GAS LOG MISCELLANEOUS NOT COVERED ELSEWHEA UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANCE >400,000 ETI!; USED APPLIANCE <400,000 BTU ............................................... USED APPLIANCE >400 000 AIR HANDLER <10,000 CFM AIR;3ANDLER>10,000CFM :`'":` K,a NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x10.00 = x 15.00 = x15.00 = x 1.00 = x 12.00 = x 20.00 =- -..x2x 25.00 5.00 = x2C 0 x 60.00 = x 12.00 =.. x20.00 = x25.00 = x35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x10.00 = I 0 &(� a2 a OD _.--. / /0.0o x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ a.a -vb PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE - !i.7 OD $ 'j Spokane County Division of Buildings