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1991, 07-24 Permit App: 91004437 AC MECHANICAL PERMIT APPLICATION FORM ';1 Irformation Worksheet JOB STREET ADDRESS: 2, & z) /6 4 CITY/STATE/ZIP: jt rd1Q„1.t p , _t1)(2_, f q,-R/,.ZPARCEL NUMBER: OWNER: mJ!?,)_, pie_4- )r P jb,,,d PHONE NUMBER: 9c-S - (-f Cr . , MAILING ADDRESS: o &Of F - 10 '1-121 921 211Or (al. 0,9,- 1,2_ (Street) (City/State) (Zip), CONTRACTOR: ae,a10A, I bot_ae LICENSE NUMBER: ._c-.7Z-61 . _C R- 370 it.)7-- PHONE PHONE NUMBER: t-/e9 - //7D Y -moi ' MAILING ADDRESS: P 1e 6'n)'7 >Jp-Ietai QQ9 o (Street) '(City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT = AMOUNT DUCTWORK SYSTEM x$10. 00 = WOODSTOVE/INSERT x 25. 00 = GAS WATER HEATER x 10. 00 = HEATING EQUIPMENT <100, 000 BTU x 12 .00 = HEATING EQUIPMENT +100, 000 BTU x 1).29 = GAS PIPING (1 - 4 OUTLETS) x -4r.-6-6- GAS PIRING (5 OR MORE. EACH: ) x 1. 00 = REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12. 00 = REFRIG 101-500M BTU x 20. 00 = REFRIG 501-1, 000M BTU x 25. 00 = REFRIG 1, 001-1,750M BTU x 35. 00 = REFRIG +1,750M BTU x 60. 00 = HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ / x 12 . 00 = /o? , Uc) HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20. 00 = HEAT PUMP & AIR CONDITIONER 15-30 TONS _ x 25. 00 = HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35. 00 = HEAT PUMP & AIR CONDITIONER +50 TONS _ _ x 60. 00 = VENTILATING FANS x 10. 00 = EVAPORATIVE COOLERS x 10. 00 = TYPE I HOOD (PER 12 ' OR 12 ' PTN. OF HOOD) x 50. 00 = TYPE II HOOD x 10. 00 = CLOTHES DRYER x 10. 00 = RANGE x 10. 00 = GAS LOG x 10 . 00 = MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ x 10. 00 = UNLISTED GAS APPLIANCE <400, 000 BTU_ _ _ x 50. 00 = UNLISTED GAS APPLIANCE >400, 000 BTU_ _ _ 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 >10, 000 CFM x 15. 00 = SUBTOTAL $ / _oO PLUS: PROCESSING FEE + $ 25 . 00 EQUALS: TOTAL PERMIT } NOTE: MINIMUM PERMIT FEE IS $$3j55. 00 FEE DUE _ $ .37` 40LALZA.A.,_,SIGNATURE I'' � '2,0ca Spokane aunty ' epartment of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675