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1993, 09-17 Permit App: 93008433 Stove, Piping Q5241 CHANICAL PERMIT APPLICATION FORM _ 51 '3 Information Worksheet �� JOB STREET ADDRESS: /26 7 E. LO CITY/STATE/ZIP: CLQ tiQ (_I.YA- 12i PARCEL NUMBER: f OWNER: C'L2,id aci Aidf.l5CX1 E.(OLv:'"1 PHONE NUMBER: 9. 7`f-• /(3%,h MAILING ADDRESS: // � (Street) (City/State) (Zip) CONTRACTOR: LLrL/rI tt OUO LICENSE NUMBER: CCcq1 /102) /off,D, PHONE NUMBER: 531-0 'A23C'/ MAILING ADDRESS: `?- () . (Box_ c_S Q/t_2 �x.,-- 9 7 ZZ(O (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = WOODSTOVEIINSERT x 25.00 = GAS WATER HEATER x 10.00 = :GAS EQUIPMENT<100,O00::BTU (INCLUDES; x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = GAS PIPING (EA OUTLET) ........::.:. x 1.00 = / 00 BOILER/REFRIG 1-100M BTU x 12.00 = BOILER/REFRIG 101, 50OM:BTU x 20.00 = • BOILER/REFRIG 501-1,000M BTU x 25.00 = B0.(LER/REFRIG 1,0001 1,750M BTU x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = :HEAT PUMP &AIR CONDITLONERsO 3 TONS x 12.00 = HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 = HEAT PUMP 8�AIR CONDITIONER>15 30 TONS x 25.00 = HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 = HEAT PUMP'&AIR CONDITIONER+5O TONS x 60.00 = VENTILATING FANS x 10.00 = EVAPORATIVE COOLER5 x 10.00 = TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = x 10.00 = CLOTHES DRYER x 10.00 = M•ANG• E x10.00 = GAS LOG x 10.00 = MISCELLANEOUS (NOT COVERED ELSEWHERE , I x 10.00 = t 0 ,oc.) UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GAS APPLIANCE:>400000 BTU x100.00 USED APPLIANCE<400,000 BTU x 50.00 - USED APPLIANCE X400,000 BTU ;' x100.00 • AIR HANDLER <10,000 CFM x 12.00 = ALR.HANDLER>10,000 CFM` x 15.00 SUBTOTAL $ (/.00 PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$3 .00 EQUALS: TOTAL PERMIT FEE DUE _$ 36.C° SIGNATURE 44 , Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675