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1992, 03-18 Permit App: 92001644 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM 6he-e- ooS _ - ` Infor ation Worksheet -�-�¢�� L7 JOB STREET ADDRES 11 - CITY/STATE/ZIP: 'a4t�/ kt/ 1 PARCEL NUMBER: " /SO OWNER: M alr Ma.x w e- ( PHON NUMBER: MAILING ADDRESS: - 96, // /0".1 cFr72O . / �,,(Stre y , (City/State) �e ri CONTRACTOR: 1 G- 7���►' it CENSE NUMBER: l� �( / � 1 /� / NE�MB R: (6t)3(6t)3 eo�g � ' �1 / MAILING ADDRESS: 66 01 S2. Xe e. k"'y. �" �'f • &SE S-1- (Street) / (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = x2 .00 = ::::.:...:..:......:..::..:........:.........:.................................................. 5 GAS WATER HEATER / x 10.00 = x 12.00 = .:.....:::.::.:...:...:...:..:....:.... GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = oz x 1.00 = BOILER/REFRIG 1-100M BTU x 12.00 = �y x 20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = .::...:....:............:..........:....:........:.....................::..:...............:.............. .. x 35.00 BOILER/REFRIG +1,750M BTU x 60.00 = x 12.00 ........................ HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 = :.iia►'.:°�::''.Kit., :``" ITS'::::,'>�:1�1f��:T"�.;:.::. :.�3: . :.:. . :.T. N ::.:: <> > x 25.00 HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 = 60 HEA x 0 0 = VENTILATING FANS x 10.00 = x 10.00 = TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = x1000 = CLOTHES DRYER x 10.00 = x10.00 = :.;:.;:.;:.:::..:::............................................................................................................................ GAS LOG x 10.00 = m16Qg11mpU3;'MiQrgOgi=.RED:.ELSoAlHEm.. >> > > x 10.00 UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = .......................................................................................................................................... ................�...+........................................................................................................................ x100 EE:' 0 0=Llt� :-:�;y::°yw;' �At3:i; >1AN`'!'- �►+� ...`,y.�:y��:';j�<<>> > > >> > > > USED APPLIANCE<400,000 BTU x 50.00 = .......................................................................................................................................... ............................................................................................................................................ x1000 0= ............................................................................................................................................ AIR HANDLER<10,000 CFM x 12.00 = Att x1500 = SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE =$ SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675