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1992, 11-18 Permit App: 92010201 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM o‘_ I Oa© Information Worksheet JOB STREET ADDRESS: 5 O al I CITY/STATE/ZIP: qz LA 99 0 PARCEL NUMBER: OWNER: lj 4rt-e.` "t © ✓ vt PHONE NUMBER: '��'7 7 L -AL MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: g*' �� `�- LICENSE NUMBER: C°-0-At F- DI*.2.7..?a Z PHONE NUMBER: 9 a le - Z� MAILING ADDRESS: //(p/6 A4 & d e y ? �d r - Q , LuA- ' q -oh, (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER I X EACH 1 DESCRIPTION OF 11NITS UNIT - AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = x25.00 = GAS WATER HEATER / x 10.00 = un 0A£E .11PM T<1003 3I'I I MONEEM>< / x 12.00 = f02 °=-'- GAS 0 GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = x = .,:.:.,:.;:.:ASF>:.:.: � ��>' ><��>'�<><`= <<«>�<> < >< <<>< 20 00 BOILER/REFRIG 501-1,000M BTU x 25.00 = x35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = x12.00 = HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 = ifttnigNittAIRWNOITIONOROWVISICIMEN x 25.00 = HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 = ifigAtiltWittAKOMMORROtflagginininai x60.00.0 = VENTILATING FANS x 10.00 = x 1 .00 = l ('CSI.�A';�� �....................:..:::::. ::: ::::::::::::::::::::::::::::. : ::::::. ,, 0 .::::...:...:....:....::. ::.......:..:..................... TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 = VertrfVWESIESRESSIEESESSSEBMEBBE x � .00 = � CLOTHES DRYER x 10.00 = x 10.00 = GAS LOG x 10.00 = x 1 .0 = :MCSCI*l.lAt+ri�S. .. 'I"�fio:�'� E .gtNW`� � �>' 0 0 UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = x100.00 = USED APPLIANCE<400,000 BTU x 50.00 = x100.00 = AIR HANDLER<10,000 CFM x 12.00 = 1500x euaitif- = -1 .�- SUBTOTAL $ 44tri` PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE =$ '1`l c_. SIGNATURE Spokane County Division of Buildings %Metet 1 Q11Q Rrnariwav Avoni Cnnkano WA QQ9R(1 15l1111 ARR-'R75