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1992, 08-28 Permit App: 92006949 Gas MeterMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: E/o 3 oZ %e°x'!,f✓f' ' CITY/STATE/ZIP: 5;74&1"7"4- 4% 5P"‘PARCEL NUMBER: OWNER: �� f't' ��/45 PHONE NUMBER: f2G �755- MAILING ADDRESS: Sri -AAA - CONTRACTOR: ,/ (Street) (City/State) gip) /t'//� LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU .... : BOILER/REFRIG 501-1,000M BTU : BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONER 3-15 TONS t:•:i1MiaMfik• • • i::isMci:Rif.F::i::1I.M#:�!P!r'i:.�l;::f :::: :::.� •: •::.: �::::: ::::::� ...v• ..... • •::::: ..:......:. �: .: •:: •: :::. �. -. :::::::::n Win::. HEAT PUMP & AIR CONDITIONER 30-50-TONS:- VENTILATING 0-50 TONS t'1 M.+.`Y:�:.�:/1f::Y►:"tM::::if:::3:twt::iia:iM�:ti�`iiii�;ir:'r::i riiiw::}::::!�:y;tr14:4: �r'c:;•::::a>: VENTILATING FANS TYPE I HOOD (PER 12OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG UNLISTED GAS APPLIANCE <400,000 BTU ::t::� c:>t►tae�yrr..w ::r.:�:�.s>srtwt:::t>Y>� i:� :x:x:x USED APPLIANCE <400,000 BTU >r=r>*>i AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 2�{0 SIGNATURE_ VT (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x20.00 = x 25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 =- x 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 = SUBTOTAL $ PLUS: PROCESSING FEE • + $ 25.00 =^UALS: TOTAL PERMIT FEE DUE = $ rision of Buildings es ' : roa • way venue po ane, WA 99260 (509) 456-3675