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1991, 01-25 Permit App: 91000260 HeaterMECHANICAL PERMIT APPLICATION FORM Inforaehtion Worksheet JOB STREET ADDRESS: i J � I/, \AnJ pt [. J J) CITY/STATE/ZIP: S g a n \A/14 PARCEL NUMBER: F/0 r! 9 PHONE NUMBER: 9 .) - ?/?/.,/,MAILING ADDRESS: a I 2 ,N \' ilib/t Jai ;' d /' J/ 4V, )/14, 5-y-10, (Street) -City/State) (Zip) CONTRACTOR: S %<( y, Phi//))2y LICENSE NUMBER: PHONE NUMBER: OWNER: LD a y z MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UTNIT DUCTWORK SYSTEM WOODSTOW/INSERT GAS WATER HEATER HEATING:EQUIPMENT <100,000 BTU HEATING -EQUIPMENT +100,000 BTU .GAS PIPING .:(EA=; OUTLET] REFRIG: '1-100M BTU(NOT A/C _ OR HEAT PUMP) REFRIG 101-500M=BTU REFRIG 501-1,000M."BTU REFRIG 1,001 -1,750M -BTU REFRIG +1,750M` -BTU. HEAT PUMP:'&: - HEAT PUMP & HEAT PUMP -& HEAT PUMP & HEAT PUMP & VENTILATING 'AIR:CONDITIONER 0-3 TONS _ AIR'CONDITIONER 3-15 TONS AIR 'CONDITIONER 15-30 TONS AIR CONDITIONER 30-50 TONS AIR CONDITIONER +50 TONS _ FANS EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE II HOOD CLOTHES DRYER RANGE GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE)_ UNLISTED GAS APPLIANCE <400,000 BTU_ _ UNLISTED GAS APPLIANCE >400,000 BTU_ _ USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 BTU AIR HANDLER <16,000 CFM AIR HANDLER >10,000 CFM 1n t = AMOUNT x$10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE NOTE: MINIMUM PERMIT FEE IS $35.00 = $ SIGNATURE IC E ,4Lg f --- Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 9 260 (509) 456-3675