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1992, 09-09 Permit App: 92007385 AC
MECHANICAL PERMIT APPLICATION FORM`�3(s5 - Ir.format; on Worksheet C\ z3� JOB STREET ADDRESS: .14 VA$ i CITY/STATE!ZIP: kJ:?Yakc' W t ilk 'nqtpPARCEL NUMBER: OWNER: . QLQ. � ,:2r-y1 PHONE NUMBER: 1 Y- 753// MAILING ADDRESS: xl /c7) ), (0.1:(2/ (j, l4 Is7 ( r70 ( treet) (City/State) (Zip) CONTRACTOR: ) 3(,)ni),tQ Chi d : LICENSE NUMBER:SE-/ 12-616-3"7o14)7- PHONE NUMBER: Liu- 5- c-- MAILING ADDRESS: PO f .300.1 k.4 AO 1-'_a., i / , 41 (Street) ( ity/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION OF UNITS ER XUNITH = AMOUNT DUCTWORK SYSTEM x$10. 00 = WOODSTOVE/INSERT x 25. 00 = GAS WATER HEATER x 10. 00 = HEATING EQUIPMENT <100, 000 BTU x 12.00 = HEATING EQUIPMENT +100, 000 BTU x 1).9 _ GAS PIPING (1 - -4 OUTLETS) x .4-:-B-6- GAS PIING (5 OR MORE. EACH: ) x 1. 00 = REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12. 00 = REFRIG 101-500M BTU x 20. 00 = REFRIG 501-1, 000M BTU x 25. 00 = REFRIG 1, 001-1,750M BTU x 35. 00 = REFRIG +1,750M BTU x 60. 00 = & AIR CONDITIONER 0-3 TONS _ _ / x 12. 00 = /0 ,400, 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 = EVAPORATIVE COOLERS x 10. 00 = TYPE I HOOD (PER 12 ' OR 12 ' PTN. OF HOOD) x 50. 00 = TYPE II HOOD x 10. 00 = CLOTHES DRYER x 10. 00 = RANGE x 10. 00 = GAS LOG x 10. 00 = MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ x 10. 00 = UNLISTED GAS APPLIANCE <400, 000 BTU_ _ _ x 50. 00 = UNLISTED GAS APPLIANCE >400, 000 BTU_ _ _ x100. 00 = USED APPLIANCE <400, 000 BTU x 50. 00 = USED APPLIANCE >400, 000 BTU x100. 00 = AIR HANDLER <10, 000 CFM x 12 . 00 = AIR HANDLER >10, 000 CFM x 15. 00 = SUBTOTAL I $ /` • QD PLUS: PROCESSING FEE + $ 25 . 00 ! EQUALS: TOTAL PERMIT NOTE: MI IM w.. , ; .-0_1111 FEE IS $�q�5. 0 0 FEE DUE = $ 3' SIGNATU ��'U� %�/ /,/ �/�/ Spokan : Co Pe Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675