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1992, 11-05 Permit App: 92009811 Mechanical Fixtures 4 }� o L -> "� MECHANICAL PERMIT APPLICATION FORM \, � Information Worksheet JOB STREET ADDR S: L. • .�� 5 �JY2L C) CITY/STATE/ZIP: \) (? COn 9C /( PARCEL NUMBER: OWNER: 56 c �l�P��� ��II1?1_t1-Fa2 / PHONE NUMBER: 77?V-CV/ MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: 26e( / pp, /7y LICENSE NUMBER: /UN C'()I-16/ / Z- PHONE NUMBER:��3j (7-C-/9 ? MAILING ADDRESS: , . . 516 �h0_11/ q'L0 (Street) (Ci /State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = ........................................................................................................................................... ............................................................................................................................................ W T V R x 25.00 = ........................................................................................................................................... ............................................................................................................................................ GAS WATER HEATER x 10.00 = GAS EQUIPMENT<00,00 BTU SINCE.FIDES:< '<>><> > >' x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = ........................................................................................................................................... ............................................................................................................................................ x 1.00 BOILER/REFRIG 1-100M BTU x 12.00 = ............................................................................................................................................ x 20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = x 35.00 = BOILER/REFRIG +1,750M BTU x 60.00 = ........................................................................................................................................... HEAT PUMP &AIR CONDIT ONE�t 0:- TOtS[S.... .. x 12.00 = ............::............::.................::...........:.....:...:.......:...........:...........:.::.:..............................:... HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 = ........................................................................................................................................... ............................................................................................................................................ HEAT PUMP &Intl=t CONDITIONER'15 3+ TONS :> x 25.00 = HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 = :........................................................................................................................................... HEAT PUMP AIR CC NDITIONER+50 TONS x 60.00 = VENTILATING FANS x 10.00 = ........................... x 10.00 TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = TYP II HOOD x 10.00 = CLOTHES DRYER x 10.00 = RANGY. . x 10.00 = GAS LOG x 10.00 = MISCELLANEOUS(N T COVERED.ELSEWHERE ± `' x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED GAS APPLIANCE X00,000 ETU, x100.00 = USED APPLIANCE<400,000 BTU x 50.00 = USED APPLIANCE?400,000;BTU x100.00 = AIR HANDLER<10,000 CFM x 12.00 = AIR:HANDLER 1 },OOO CFM.... . ;..<>< ::.:. ........ x 15.00 = SUBTOTAL $ (fz) PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT QJ FEE DUE _ $ ' (2' SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675