1994, 10-10 Permit App: 94009564 Furnace, Piping 05Zg 2- 3`--11g
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K-iq^oMECHANICAL PERMIT APPLICATION FORM I q 5 Lp
ci
JI Z 1l� S Information Worksheet OI�I f
JOB STREET ADDRESS: 02o-d 5 11
CITY/STATE/ZIP: LO / Q q PARCEL NUMBER:
OWNER: e t1 I 0 I c 0 e PHONE NUMBER:
MAILING ADDRESS:
' II(Street) (City/State) (Zip)
CONTRACTOR: Deer- Por- f-1-(0,k(,;tc� `t (I-/C, LICENSE NUMBER: O 6- i S r o g (to S
PO
J PHONE NUMBER: D-7(c,--�'`F3 C,
P
MAILING ADDRESS: be, /3'3), nee r �u -L (.ti/9- c' 0
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
hii. ;BER I X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
iiWOOMMettiganIMEREEMENMEMES x
25.00 =
GAS WATER HEATER x 10.00 =
:: AS. :QUIi:'::gIkfggw1o:tWV{1:NGWO::; >;;:>:.:.»:::::.::.::::.:::>:, /
x
12.00
2
vO
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS '11:�I...�'a.>� Kat.::.::::;;>;;:;;:.::.:;:.;:.;:.;;:.:.;;;:. :�::�:::::: ::�::::�:::..................
x
1.00
I
OBJ
BOILER/REFRIG 1-100M BTU x 12.00 =
x 20.400 =
BOILER/REFRIG 501-1,000M BTU x 25. 0 =
x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
=
:N:�'�':f'Ut�f'> �tt�O.�r�1pt'Ca �1�K;�:;.;�:..;:;:Q �:.;:.:<.:;;»:.;;>;:.::::::::.
x 12.00
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
: - :::;::;:. : : :< >>N x 25.00 =
'i tA. '::<.��iuf�<'�'`>:<I:: : t�Ni�f'Cat�O>�:y�;.:�t�;7;{���.:;::.;;:.:;:;;;.;:.:
HEAT PUMP&AIR CONDITIONER 30-50 TONS _ x 35.00 =
x
60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVEW,: S .. ....
x
10.00 =
T Esc , !FOOD (PER 19' OP 12' P114. OF Hnnntx 50.00
x0
10.00 =
CLOTHES DRYER x 10.00 =
x 10.00 =
GAS LOG
x 10.00 =
1 .00 =
MI : :aLAN5�7►C)S>'t�:C�'t''oO�IeK:tl=bI=LS�ILV..;.;:�;:::;.:;:.;:>:.;:.;:.;:.;;;�.;::.;:
x 0
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINS�"ED GASAPf'LIANI ��40Q,t�E7C�: aU
x100.00 0.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
x0
1 0.00 =
AIR HANDLER<10,000 CFM x 12.00 =
AIR HANb[.EROCpQQ�F >;:;:K ;;;;. ....... ......... .. ........:::.
x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT �j
// FEE DUE _$ 3O 'fid
SIGNATURE .
ijis .
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Spokane County Division of Buildings