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1992, 01-28 Permit App: 92000468 Fireplace, PipingMECHAN!CAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: /V // o2 1tasiovi F- CITY/STATE:ZIP: 6'00( 1,7> Ii Zi? PARCEL NUMBER: OWNER: J tf) )t- A5Y PHONE NUMBER: 9215 0963 MAILING ADDRESS: 547111: -- (Street) /'' (Street) CONTRACTOR: AJ70N1it. G -/h7M' e MAILING ADDRESS: DESCRIPTION 7 6/b gfA740wvi-ei (Street) (City/State) (Zip) LICENSE NUMBER: /1.4-79CS'/C2 A9' PHONE NUMBER: e/ZZ'(20 540/C- ja1m 41 ? (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/INSERT GAS WATER HEATER 'GASEQUIPMENT G100 000 BTU (INCLUDES : GAS EQUIPMENT+100,000 BTU DUCTWORK) -001:01. .0. 15(4A OUTLET); BOILER/REFRIG 1-100M BTU BQILER/REFRIG 10i;'S00fMBTU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,)001 1.750M BTU BOILER/REFRIG +1,750M BTU HEATpUMP;.& AIR CONDITIONER 0 3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS BEAT PU M,p & AlR CONDITI ON ER 15 '3Q TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS iHEA-FPUMPAiiAIRCONPITIQNE13.*503QNSIgir VENTILATING FANS EV..APORATI.VB COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) 1 PEIffiiQQt CLOTHES DRYER GAS LOG M. SCELI.ANEO(iS(NOTCOVERE1 ELSEWHERE:,.::: UNLISTED GAS APPLIANCE <400,000 BTU ULINST.EDGAS AP'PLfANCF.>40Q000 STt)„ USED APPLIANCE <400,000 BTU USED APPLIAI4CE?dOU,000 BTO `"' AIR HANDLER <10,000 CFM A1R HANRLER,?10,O0 CFM :.. NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE �/ °� 0 NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x20.00 = 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 = x10.00 = 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 = $ pokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675