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1992, 10-02 Permit App: 92008390 Mechanical FixtureMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: V"?.... V A LLEN may CITY/STATE/ZIP: S PO f L 99j( 4 PARCEL NUMBER: 7. 37 1 0 OWNER: G,�=HALO F FP Le.h>.D i 4J PHONE NUMBER: MAILING ADDRESS: 5 A - (Street) CONTRACTOR: SEL MAILING ADDRESS: S (City/State) (Zip) LICENSE NUMBER: FAll�Cc��9 7n�J PHONE NUMBER: qt 21- (9RS-4-1 (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) jM yy::}}•.vf.•:y::•nwxnx.:vv:..-r xl:•};r: •Y, yr •. yv .4} . f :^HFh: a. ?,::.,.,vv,<,r.•..:w.,-::.w:::.,:}..,..::.....w:,,•::::::.-:::.:.•.,.::.:: r...,,:v.{w.:,::w: � r.•.;{•r ha.-.,...X,.w x:,:•N}:>::?}:: GAS WATER HEATER . �mv{4ix;:.•rr.:::,}•.:}:;::wr..nyry vr.Y:{M frx:.v.::{:rfv,�::: :v::;: rvr: :.vl'.ix}-•iy{.::•: F:: y: .yvyx%v-}n...v:.-v,;.;:.v:• awsr:.,,w.,.h:•r.dir-rx 4av:hvn,,:a,..z..• •-.. •-- :.a-.a;r;; GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU 1errSKt }r J • A{' �iff.4 .%v Ci?.S�tiv}:¢aiOJ BOILER/REFRIG 501-1,000M BTU_ ,,,,yrxx,::::::::.:.::..}::•,xr:;.{.t:.{�.,::.{r.,k.�,,,.::.v„, .;r.�:.: xr;;;H.f sig{M,.:N{.,y:N, x.:w .x,mnn,:.;v};,:. :k, .�. uv}h;AvMv }h4.i^h,:{,,, ,V,WY} wX:i}ihi 4;- ..... ... ..,,. , wY.a,w:�,.rr:.,,•.,-..r�kx:d:Y,w.„aw.....�a;.:awlr.:h"w�: HEAT PUMP & AIR CONDITIONER ....... v:.CONDIT.. IONE�:rhR,}.3-15 TONS �:x 1a,•a wa��}�i�talfajk�erK6 wxP�»r}s.^ HEAT PUMP & AIR CONDITIONER 30-50 TONS Lv;+nvr{r{.v:: x::{:.y{l:r:': r:�r{S;-:•M4� e?{O!:::yrx(vry:�vx;vreytr.: fxf . jj�! ryryl::rry-Y:r 17/�r��rVry %r'}tt{^.^}t{. `�.���4��leYrf{��� �x����}.rv'.••��}�+�.��Uh.:m•:��'FF�vFv��:}�•-v`+v`�C- VENTILATING FANS �iy;•�iiii:;:{�xr,�x}�.��tiis.hy%+.- i+ >rv:::Q:,:;:.{rr iv"i,����•`"•TCW..>.•...bJ:�S:FO•W.• v�n3` =?�. $}. •: 4.v}.tivvxw:v4:.,i6h}Y)AiC4YYn' 'Jvhrhv ki�b�k5�J' TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) xy.}• rr.}uxvn:vxv : •}Y y .. .,h !�`jil�c. :.<. {j�.!�}�j ..r, '�:-sem'.•} . v`ker.- �i'�;., :r;��1Aiyt'%1:1�h..a. Z{},;:h;�#i;{ ���?�pw*...�.�•�a~.:�v{.}•�;.,�{:t,+,� p}:{-��.; >s{,.ar {.;;s�',;>v :{: `s'. i.r}':).:.:, ... .::{-}•rfhiici:i�'t;r;t::::;,,•:.,fS,yVc:�aY�ac•:�;;•x.,�a.;,io�S :o-w.u}kbo-3trxy:i •: �r�}-.}-}::}..:..� CLOTHES DRYER S"` CW,![: -';a;>S:y. :�;{{.:: -{,y r.'•::fi:;<:-5:`>r;:::::;•E>..�;;:�,_:<;.R�.{,••,: `tr:<:;f':a::V�;.ys,M �1!l,:TR i'.i:Y::. f}:r$ J Ori v xi:{r:: •vi�:*::j.4},+�:SW tAln i �F� f},vYf•,}j�;Y.:`v'.:�;.'{.:.{ x,:r.,vw:.,-.:,r.:•}:',•::':"`5:'�.,.v.,.,:.:.:,v�;:rt3::t:{; �.>?"4�':2:a2�'a;°.}v'.,'..::-J�•'.;"v,:a�wi.+m£{}-''a?:nC:;v'.:5:: •.,.. GAS LOG BOILER/REFRIG +1,750M BTU ;.y. • Awa .*••••"..:”4"'''''•v,""•:yyyxxr:x`• • •: n• ::•v: ..w{-..4ext..:.J4:w.,..:i:.�r!Y2 1;{;':A.'+•.'.v.:-,';! UNLISTED GAS APPLIANCE <400,000 BTU +•.:};.y}:••.}v}•:.y,.}}•^xny::�vn•.} .: •4.}�i}}}:,y :h:}•xf.•.y:.{r.:r'v'• v'r'•'iY.•;•'.}:{}}}}}'-i}•.}?:-: .}�•Y� a' [AJ,A} �� }�- vv x: uOri I Y 1Rf.�",S-Y{}{i.} }4+.v', : S•:": m...{...i: v..,v.:.x•.v:+u \:xr:: wv..::N::f}:rid': }•':%Y�:.v:ii:'-jti;iv.Jnv.:', USED APPLIANCE <400,000 BTU AIR HANDLER <10,000 CFM r.r.r::.rnr:: nv:,-.,,...•...vm.n..... r..4vi nM1 �:i� NOTE: MINIMUM PERMIT FEE IS $35.00 NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00 = x1040 = x 12.00 = x 15.00 = x 1.00 =. x1200 = x 20.40 = x25.00=. x35.00 x60.00= x12.00 = x 12=0./0/0 . = x: .00 = 25 x• 35.00 •._ x 60.00 =' x 10.00 = x 10.00 = x 50.00 = x 10.00 = x14.0 = x14.00=. x10.00 = x10.00 = x 50.00 = x100.04 = x 50.00 = x100.00 = x 12.00 = x 15.00 = / .. s SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675