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1993, 02-10 Permit App: 93000751 Mechanical FixturesLid5ya\ . \4a g4 026'7 ts 5 MECHANICAL PERMIT APPLICATION FORM - Information Worksheet JOB STREET ADDRESS: AlcY00 catittas-Q-e-tr CITY/STATE/ZIP: 4SpasQataeLaLuPARGLEL NUMBER: • OWNERrn-res a. LAD: c -In 'Moon PHONE NUMBER:gale-591g MAILING ADDRESS: 6 (cL- L 73:T_ .--77 5/ (Street) CONTRACTOR': U3CA6-Cit425 l'-tdcaly) MAILING ADDF(ESS:'7.E3&O'4 ' DESCRIPTION mica 1 (Street) (City/State) LICENSE NUMBER: PHONE NUMBER: -56,01<4ww, LOA (CIty/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) 100023201MOYESISTA.rgs: jag GAS WATER HEATER 1.611:011NPITKPKOMPARRPARtrin GAS EQUIPMENT +100,000 BTU DUCTWORK) lfattiMPAailz.. BOILER/REFRIG 1-100M BTU gaga!tillMagt BOILER/REFRIG 501-1,000M BTU EIVERVIRMISMIOntuff '‘m" rcj BOILER/REFRIG +1,750M BTU lsrnw figArPiilftrainteiNDIT400016,4grON4414t, HEAT PUMP & AlFrCONDITIONER 3-15 TONS IHMINIMPASIDATPITIONfillift410101401111 HEAT PUMP & AIR CONDITIONER 30-50 TONS 1,411P.M.K.O.Mtattakialtiltafati VENTILATING FANS IPAPPIWOMPRIMIEWIINNWW1,17 TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD) BRE H-Ottligterar" hsanps CLOTHES DRYER INNWatrtee "21111MM - - - - - PINSWIAMEROIMENNIMAIIM• UNLISTED GAS APPLIANCE <400,000 BTU Ig1111141:PARIMPIZONIASSEIME USED APPLIANCE <400,00a BTU iggalCONAINIMMIS 74, PNIITIO AIR HANDLER <10,000 CFM WINANOK02101,41Mialttlittlitio • NOTE: MINIMUM PERMIT FEE IS $35.00 ' SIGNATURE • (Zip) -1--r4c_tot (Zip) NUMBER OF UNITS X EACH UNIT m AMOUNT x tom . x25:00 . x10.00 et x 12.00 ..1• x15.00 x 1.00 x 12.00 n x 20.00 es x 25.00 al x35.00 x60.00 = x12.00 = x20.00 = x 25.00 = x35.00 x60.00 1.1 x 10.00 = x 10.00 I= x50.00 .w. x10.00 = x 10.00 es x 10.00 rs , t0.00 x 10,00 = - x50.00 n x100,00 ,,, x50.00 .• / /0, 0 0 / 41.1 , - , , - __ _____ - - - , x100.00 = x 12,00 = x15,00 ,,,, SUBTOTALS $ A q,o�. PL U_: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =s 4/9,6 0 Spokane County Division of Buildings • „West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675, •