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1993, 02-01 Permit App: 93000542 Range r J MECHANICAL PERMIT APPLICATION FORM Information Worksheet _ �. JOB STREET ADDRESS: S E-2'2- CITY/STATE/ZIP: .5d0o ,-c- X14. 99-11G, PARCEL NUMBER: OWNER: •-SaL I mo,V ti'/mort1 PHONE NUMBER: - 9.22 3 7 a 3 MAILING ADDRESS: - 5 Spe• '` u' ';. 97-1/6 / (Street) (City/State) (Zip) CONTRACTOR: � -t � c� LICENSE NUMBER: 6AJE5- " OYI m /PHONE NUMBER: � ? � 7 � Z MAILING ADDRESS: /o�G -��j��'� M`y Z&- / Z6, 9 Q I (Street) V (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT = AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = x 25.00 = GAS WATER HEATER x 10.00 = SAS EQUIPMENT <100,000 S'IU(INCLUDES [:: _ x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = x 1.00 = BOILER/REFRIG 1-100M BTU _ x 12.00 = 2 .00 = 80ILEC�IREI=1�fa a01-5C�OM 3TU........ ': .<:>:`::; .::':`>:::`::>'::: . x 0 BOILER/REFRIG 501-1,000M BTU x 25.00 = x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = x 12.00 = HAAT SUMP�AIR�CJNt�I'CICyNEFl 0-3.TONS ```' :::.:`' HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 = HEATPIJMP;vAIRGO.NDITIONER 15 30 TpN25.00 S :>:: x = HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 = HEAT PUMP&AIR CONDITIONER+50 TONS ' :'. x 60.00 = VENTILATING FANS x 10.00 = IVE L��i x 10.00 =::::::::::::::::::::::::::::::::::::::.................... .......................... TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = x 10.00 = .... -_ CLOTHES DRYER x10.00 = •RANGE x 10.00 GAS LOG x 10.00 = MISCELLANEOUS(NUT COVERED ELSEWHEIR <>`' : : ` x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GAS APPLIANCE>40(Y000 BTU '<><' :` < " _ x100.00 = USED APPLIANCE<400,000 BTU x 50.00 = x100.00= AIR HANDLER<10,000 CFM x 12.00 = AI R H ND;I R>10,000 CFM..:: x 15.00 = SUBTOTAL $ /° '-' PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT - cin FEE DUE =$ 3C _ SIGNATURD_7) + Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675