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1991, 10-14 Permit App: 91006816 Insert
MECHANICAL PERMIT APPLICATION FORM �/ Information Worksheet JOB STREET ADDRESS: `/' PCZ-3 GLJ//Aeo- CITY/STATE/ZIP:, ,//G/7L /c.Yt 9IZd.a PARCEL NUMBER: OWNER: /ec/C/r L.56t)f PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: (6y✓i(- ac' LICENSE NUMBER: CGrc.//ei . /077Z;-)-, PHONE NUMBER: 5jf-(fJC/ MAILING ADDRESS: U406/eCe,4LGL 9c/22(-) (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = <WOOD _ .....-. ..V IN ER' ` > < < > :;:lE_: >taggi ><l x 25.00 = GAS WATER HEATER x 10.00 = ,.fia- _$ QU;e:.::;:g;:.;:.;:.;:.;;;:ooma movi 3DE ...ai::::-::;::>: :::: x 12.00 GAS EQUIPMENT+100,0.00 BTU DUCTWORK) x 15.00 = x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = MilittrafilltailliSOMOMINESEENINGESx 20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = =:OCA EE G<= 1 '7 M 10011•1511111111" x 35.00 = - . BOILER/REFRIG+1,750M BTU x 60.00 = . N:n:k: :f El tronMP&AIE CONDITIO1 ER U-3_fiONS... ns>=::>=:>< x 12.00 = - _ HEAT PUMP&AIR CONDITIONER 3-15 TONS- - ) x 20.00 = x 25.00 = HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = _ _;:.;::.::._:_;;:.;;::. x 60.00 VENTILATING FANS x 10.00 = A IVE:;__<:.::;.:,.;::: , >> nmess `= >`== <>`>===<om = �:VA�' pA'�....�CC�IER$-- - ------------------------:-:::::<; : >::»__>_:::>::>::>::;_:::_: x 10.00 TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 = x 10.00 = CLOTHES DRYER x 10.00 = 'RAN_.:. __> » ; = '> < _< <<=> <<>'` >>' > > >> = GE . -_:. . . ...:. ..::::... .:...; x 10.00 GAS LOG 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 = x100.00= AIR HANDLER<10,000 CFM x 12.00 = AIR HANDLER>10,000 CEM \ x 15.00 = SUBTOTAL $ . S',vv PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE =$ 50,E SIGNATURE (tc%1(:+? Spokane County Division of Buildings West 1303 Broadway Avenue Spokane. WA 99260 (509) 456-3675