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1991, 10-31 Permit App: 91007455 Insert MECHANICAL PERMIT APPLICATION FORM / / Information Worksheet JOB STREET ADDRESS: • cc�fol- I��✓C'.L � CITY/STATE/ZIP: dpOiCa,u. Ltd PARCEL NUMBER: OWNER: CIGcct Tt i I rna,ti_ PHONE NUMBER: 92'1- y,36t3 MAILING ADDRESS: (Street) (City/State) //,n, � (Zip) CONTRACTOR: (Ctvj'-/ ice. jPj� /(Z/,S LICENSE NUMBER: 2y/'ice. �"i'Cx1L 9e _ PHONE NUMBER: 6<3C0"cF.3Co MAILING ADDRESS: / l��34-��4�J ��6(,)44 •�' -- i9 l 9Z ,c,) (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = x2500 . = GAS WATER HEATER x 10.00 = pagOtelmogloomoAlimptoggpEgaggigeni- - x12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = f.v{:.-.i:.y::.vnv{n,vC:::: r:nv:r::fii}i-iYi:4:i:?ii:yLti:.;i_.n:v::?:r: i_i:::g:v....}.::t}:.�:.::.:,.:::n_-:rv:.:.:..}}}:}v� x2 = ��.yy/�f }Jy!�( }}��y�{'�y���-'{r/�� �y ��. .��y.}�y�'- '.�..�'i:....:vv:::vi:is�:iy:3}:si'v::�i::<i: ::i::?: ::i:::::i 0.00 �;00#. SiiEl�f7li!i�V�'�W�.....-�.�..a.�.-..-.....:............................................... BOILER/REFRIG 501-1,000M BTU x 25.00 = LOMPitigt0114104iiiitiNatorminifilisiding x 35.00 = BOILER/REFRIG+1,750M BTU x 60.00 = NLL mxpx,_v:. x:Fiti-v:u;wvypyv:pr:-.vu.r:::_WF}:-nor:nxx::rn::x:rii{.:•::{:rvn:v-:xv::n?i•L::.iiiii?.............ii:.:;rr..:_ .HEAT PUMP: ._AIE CQNDl `(Ot ER._0-3.•T ONS..====:: �=====' .._:; x 12.00 = HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 = _HEAT PUMP 8,AIR CONDITIONER 1 30 TUNS::::::._; \ x 25.00 = HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = HE14'tPU:MP:: >iR#tEt:o'?1�bIT1C�N�EP'f-��0''tflNS>==<==<:�>< >:<:.::-::.::< x60.00 = VENTILATING FANS :...:.............. x 10.00 = - - = x 10.00 = TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 = x 1 = TY..1=.t .HOOD ................ . . CLOTHES DRYER;:._;;;:.. x 10.00 = x10.00 = G GASLOG�:::............. .....................__..................................-.................................. x 10.00 = __.. ...................._............._......_......................................_..... ' MISCELLANEOUS(NOT COVERED ELSEWHERE x 10.00 UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GAS APPLIANCE>400,000 BTU x100.00= USED APPLIANCE<400,000 BTU x 50.00 = ........................................................................................................................................... 00 00 x1 =: ED:APPLIAN AIR HANDLER<10,000 CFM x 12.00 = ......................................................................................................................................... AIR HANDLER>10 000 C.FM ':`' x 15.00 = SUBTOTAL $ S,cO PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE =$ 5a.0 SIGNATURE iC A..[.c,cx Spokane County Division of Buildings West 1303 Broadway Avenue Snokane. WA 99250 (5091456-3575