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1991, 05-03 Permit App: 91002298 Piping MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: g/6 Ls. bi/L- (____, , / /7 CITY/STATE/ZIP:- ,S.-/€90k4-J29/1. ii4. - PARCEL NUMBER: • . OWNER: k_--&',/C 77.6' .ES OP, PHONE NUMBER: -2 7 -- =),,...-)--9 7 MAILING ADDRESS: < r,t9- ,-E (Street) (City/State) (Zip) CONTRACTOR: //--/C.1- . 74-,e _.i7:---- LICENSE NUMBER: /y/,4-------t��f_/f76by PHONE NUMBER: f)- Y(22C' MAILING ADDRESS: 41, /2(..)k /f 1yt S--Pe)l1-1 rid/-t.1/i 9,,--0.1. ,2s._ (Street) • • (CitylState) (Zip) - MECHANICAL WORKSHEET/FEE SCHEDULE • • - - NUMBER X EACH • DESCRIPTION - OF UNITS • UNIT-. =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = " x25.00= GAS WATER HEATER x 10.00 = 12. = GAS��QIJIPMt :�`> � ��'i3:{�.;:.; u3p;:>5::_:.::.;:.;;:.;.::.::.;:.;:.:.:.:.. x 00 GAS EQUIPMENT+100,000 BTU DUCTWORK) . x 15.00 = :GAS PIPING(EA JUTLETj / x 1.00 = / BOILER/REFRIG 1-100M BTU x.12.00 = . :8011 41101 4*§POM. :Til::<::: ;:_;:<:,::,:.;:.;:.:: :-;;:. :. x 20.00 = . • BOILER/REFRIG 501-1,000M BTU x 25.00 = BOILER/REFRIG..1:00.-1 750M.8TU.<: <>s >:: ::::r _r:: "' :v:<_ - x 35.00 = BOILER/REFRIG +1,750M BTU - x 60.00 = HEATPUMP:&AIR,CONDITIONER 0-3 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 = EVAPORATIVE COOLERS - x 10.00 = TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 = TYPEII HOOD x 10.00 = CLOTHES DRYER x 10.00 = RANGE::::,::.....:.:.;:::::..:. :.......:.. , x10.00 = • GAS LOG • x 10.00 = • .,MIS LLAN US +fOT COVE tED £WHER> :> > h: . x 10.00 = • UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = . 1 0= >1a�NS'T'.ED .:::::::::::�:[::::.�:G::::: ::::Q0�{ .::::'I'tl.:::::::.:_:::::::::::..:;;:.;;;; . x000 USED APPLIANCE<400,000 BTU . x 50.00 = >B>:. > `:�: >><: ><:>�< <:><>::.:::..:.......... x100.00= .:::. . . .:.. • AIR HANDLER<10,000 CFM- x 12.00 = . -x15.00 = .9ik 7 Tx..!- 7'0/' O n' /b id SUBTOTAL ' $ • PLUS: PROCESSING FEE ' +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT - -- FEE DUE _$ I`S_-` / . SIGNATURE .ke T , . . Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675