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1991, 08-01 Permit App: 91004690 ACJOB STREET ADDRESS: CITY/STATE/ZIP: MECHANICAL PERMIT APPLICATION FORM Ir.,formati//on WorksheetCd- 3-7P6 ftt(D t i?) q9706? PARCEL NUMBER: OWNER: I)fw - vvvt &i& MAILING ADDRESS: CONTRACTOR: f MAILING ADDRESS: PHONE NUMBER: / c) 4 C, E- 7 5s (Street) pea (Street) ` ( 2a,f/LP ,0)4-9q/2 c City/State) (Zip) LICENSE NUMBER: se- A-P��cLti�T- PHONE NUMBER: //48q- i I i 0 SC ,3 c/ f°C /ciaa_ 4I�, li) Q9.21ar6 I(City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH OF UNITS UNIT DESCRIPTION = AMOUNT DUCTWORK SYSTEM WOODSTOVE/INSERT GAS WATER HEATER HEATING EQUIPMENT <100,000 BTU HEATING EQUIPMENT +100,000 BTU GAS PIPING (1 - 4 OUTLETS) GAS PIING (5 OR MORE. EACH:) REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-500M BTU REFRIG 501-1,000M BTU REFRIG 1,001-1,750M BTU REFRIG +1,750M BTU 0-3 TONS 3-15 TONS _ 15-30 TONS _ 30-50 TONS _ +50 TONS HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER VENTILATING FANS EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE II HOOD CLOTHES DRYER RANGE GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE) UNLISTED GAS APPLIANCE <400,000 BTU_ _ UNLISTED GAS APPLIANCE >400,000 BTU_ _ USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 BTU AIR HANDLER <10,000 CFM AIR HANDLER >10,000 CFM 1 x$10.00 = x 25.00 = x 10.00 = x 12.00 = X 1 x 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = Spokane Coun � epartment Building and Safe 1303 Broadway Avenue Spokane, WA 99260 (5 NOTE: MINIMUM : �T FEE IS $35.00 Spokane Coun • epartment of Building and Safe 1303 Avenue WA 99260 (5 SIGNATURE SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE West 09) 456-3675