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1992, 11-18 Permit App: 92010189 Insert, Piping MECHANICAL PERMIT APPLICATION FORMI b\ Information Worksheet JOB STREET ADDRESS: 7 r /C j( 7 (i W..ele CJO4/ 212 0.0 CITY/STATE/ZIP: ,. " rj4,e (i. 4 99-2 /r>2 PARCEL NUMBER: OWN ER:= ./PE_S Es/eN PHONE NUMBER:.h J i- 4/9 MAILING ADDRESS: 0 ,1/Z/' (Stregt) (City/State) (Zip) • CONTRACTOR: ./-?f GP,%i.- t O/V C:,TS LICENSE NUMBER: L,/ SGP//0d (� PHONE NUMBER:�O t ).62(0 -E-P26/ MAILING ADDRESS: PC )‘ D.1/0-if 61h 994g6. (Cityt tate) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = INOOISTOVEIINSEIT x 25.00 = GAS WATER HEATER:.;:.:;.:.;:............ .................................. .......... . x 10.00 = G S EQUIPM N <100,t 'U INCLUDES <:`> '` x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = �; S.�.P�N�.( ouTLE�.. .. ....... ........ ...... .... . .. ...:. : j x 1.00 = CO BOILER/REFRIG 1-100M BTU x 12.00 = x 20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = BOILER/REFRIG 1,0001 1, '50M ETU' `:.: >: x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = HE TPUMP AI CONDITIONS=R 0 TONS ..:`: x 12.00 = HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 = HEAT PUMP:AIR CONDITIONER 15.-30 TONS:'>: '< ::': x 25.00 = HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 = HEAT PUMP AIR CONDITIONER+50 TONS <:.'' x 60.00 = VENTILATING FANS x 10.00 = YAP V`'01� x 10.00 = ..............:. TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = x 10.00 CLOTHES DRYER x 10.00 = x 10.00 .. ....................................:>:.;>:.:>;;:.>::.>.... .. ..... GAS LOG ::.. :.: x 10.00 = MISCELLANEOUS(NOT COV : ERED •ELSEWHER x 10.00 = f 2, 66 UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GAS APPLIANCE>400,000 STU x100.00= USED APPLIANCE<400,000 BTU x 50.00 = ED:: <pPL x100.00= 1AN t=.�t - AIR HANDLER<10,000 CFM x 12.00 = ;Al>� x 15.00 SUBTOTAL $ 400 PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE =$ j&.06 SIGNATURE Q6i9a.""'- Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675