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1992, 11-06 Permit App: 92009842 Furnace, Piping MECHANICAL PERMIT APPLICATION FORM Of lrrz?i46,,Q, Information Worksheet ` 3/( / Q �, JOB STREET ADDRESS: 1 O�` F, , r Q // / /� CITY/STATE/ZIP: Oil-)k� _1 l R��A. 99�bC PARCEL NUMBER: n� S �') `(� . O I OWNER: 4UGUS.. 1e'cOWD I37 PHONE NUMBER: 1a'4- ' I`7 I CP MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: I L 1 '1 . (--J LICENSE NUMBER: n ii-,� PHONE NU BER: ( - Q MAILING ADDRESS: �` . , �. , A�ru Q 4 wA Q 9C� (Street) (City/State (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = WO 0STOV INCggri..:._:...:.::::. >> '<.`: : '<`::: ........ x 25.00 = GAS WATER HEATER x 10.00 = .GAS EQUIPMENT<100,000 STU{INCLUDES 1 x 12.00 = 1 C GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = -,...:.._:%.,..,...........,-..,...............A :.: 1 : ; ........ .. ; : x 1.00 U: : ; .; BOILER/REFRIG 1-100M BTU x 12.00 = 13igIMiIiEII01��-aft).:.:::.'>"U:::. :::::.;.:;;;>;:<.>:. .;:;:;«.: .::::::::.: x 20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = BO L;ER/REFR:IG 1 F0001 1,750M B TU:>' "migi!>: >;.. x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = HEAT PUMP'&A IR CONDIT ONER 0-3 TONS : `'::. x 12.00 = HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 = H EAT PI JMP AIR CONDITION ER.15 30 TONS .; : >` > x 25.00 = HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = HEAT PIMP; ::AIR CONDITIONER+50 TONS :>` '::: x 60.00 = VENTILATING FANSx 10.00 = EVAPORATIVE;;;:.;:.;:C:.;;::;;;:;;:;:.;:.;;;::;:<.;;;:;:.;;;:.:::.;:.;:;:. : 1 x 000 = TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = TYPE N't HOO:.... ......... . ;::::.>..;.:. ....... 100 = 0 x CLOTHES DRYER x10.00 = RANGE ......»<:> <::>» x 10.00 = GAS LOG x 10.00 = MISCELLANEOUS(NOT COVERED ELSEWHER >:>:':: < x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = _ ULINSTED GASAPPLIANCE>400,000 B"('0.Ii :.: ' : :;.:.:. x100.00= USED APPLIANCE<400,000 BTU x 50.00 = USED APPLIANCE>400,000 BTU $::<:.:. '::::::::>:';' :r;.........J' >:::>;: x100.00= AIR HANDLER<10,000 CFM x 12.00 = AIR'HAND gR*1.0,000 CPM °?; :< :< '`: ::. >:: .:::............. >;;. :::;>s x 15.00 = SUBTOTAL $ 1e),CO PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE _$ L. .-CD • SIGNATURE .I9, 1 6)3.. .Q,A)-k_ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675