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1991, 10-01 Permit App: 91006378 Furnace, Piping •i MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: T /0 8/5— CITY/STATE/ZIP: S f',L G+Jz4 , Q 0 PARCEL NUMBER: OWNER: 7h/./c 7/E' e- L PHONE NUMBER: 92s-- MAILING ADDRESS: (Street) (City/State) Pp) CONTRACTOR: u(CENSE NUMBER: /V,} I'/c) Cs- /o X-01 PHONE NUMBER: 22 - D O0 MAILING ADDRESS: £ 73/ PO iDej/1yS NC. ej/9 f� 2 (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = IN fSTOVi:la:_! - x 25.00 = GAS WATER HEATER -- - x 10.00 = QIJlP.1 : Ia1CLU DES >h :; / x 12.00 _ • - GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 _ - - - x.1.OD: BOILER/REFRIG 1-100M BTU x 12.00 �-•^^•A• --A-moi:�.,..;,...,::::.:;.;:--s=sem sx:s_>_>:<::�:.: _>as:_>«:�:---.. ._., -- ::: • ,X20.00 BOILER/REFRIG 01-1,000M BTU - x 25.00 vwyun,�rn::v:::rir .+N::?ixxxr •yirv;:?rnvw Kf:::::?_?::-:i:}_•:: :i-iYx{wiiei. ` aOM>1T ;x ti x35 00 = BOILER/flEFRIG+7,750M,BTU ` I I IE 1ECTriD•• t3 P TONS f% 2� HEAT PUMP&AIR CONDITIONER 3 15 TONS x 20 00 = y 1IEPUM C :.. TONS Y O�:iAT: ivV.i+: iw HEATP ...�� . •�,AIR,�C® �, � � � ►�� 0=50�TONS.���� �- ;9 r �i '> � 1 1 � � , - s.*:4,' +. °t-s - VENTILATING FANS '4 • TYPE I HOOD(PER'.12';ORt12'PTN."OF ....i. .- }� xypwM ?iIMIrcIETIE: wni CLOTHES DAYER x'10.6071'.:!.: • yu-..9ix,:},,-�M.� ice; ;=::-a=<:t;::��::::::r;��: ;:.«,;,:,:_.•.•-:N :r�: � ,sem. '�2:�.: :.. . x 10.00: GAS LOG ' x 10.00 MSCLLAN.EOS: NO,tCdVEED.E,LSWHEE «a: x 10.00 = UNLISTED GAS APPLIANCE<400.000 BTU x 50.00 = outtsjgq04;5:impoNaogsoomolgilVankitiidint\ , x100.00= USED APPLIANCE<400,000 BTU x 50.00 = ED< 'US '`�P .f ......... ........ ........ . .::,COQ.: ..---........- ....--.....:::::::.::::::::.::�:�:��:-= x100.00 AIR HANDLER<10,000 CFM x 12.00 = AIR HANDLER>10 000 CEM x 15.00 = SUBTOTAL $ 3 PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE =$ 3 SIGNATURE — •okane County Division of Buildings West 1303 Broa• av Avenue Snokane_ WA 992Rn /5n91 45R-RR75