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1991, 08-02 Permit App: 91004710 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM ��ryry Info�rrmmation Worksheet ..YJ JOB STREET ADDRESS: CITY/STATE/ZIP: Y111.0.4Om a .//li • 0I9,-J&p PARCEL NUMBER: OWNER: PHONE NUMBER:: MAILING ADDRESS: o lb Y p/ d- Jllf/ 12L. ` P (Street) (City/State) (Zip) CONTRACTOR: V/ ,m J !& A 4-pl - LICENSE NUMBER: S?- - "-OY12. - .3%Zl(lT //I��yr� //�� PHONE NUMBER: �4^(gq.Jl%0 Y'3c/�i MAILING ADDRESS: A /A 3 �O % 4"A&ca, , ffi4g9c)07 (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION I OF UNITS I IINIT I = AMOUNT DUCTWORK SYSTEM_ _ _ _ _ _ _ _ _ _ _ _ _ WOODSTOVE/INSERT _ _ _ _ _ _ _ _ _ _ _ _ GAS WATER HEATER _ _ _ _ _ HEATING EQUIPMENT <100,000 BTU _ _ _ _ _ HEATING EQUIPMENT +100,000 BTU _ _ _ _ _X GAS PIPING (1 - 4 OUTLETS) _ _ _ _ _ _ GAS PIING (5 OR MORE. EACH:)_ _ _ _ _ _ REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-SOOM BTU_ _ _ _ _ _ _ _ _ _ _ REFRIG 501-1,000M BTU_ _ _ _ _ _ _ _ _ _ REFRIG 1,001-1,750M BTU_ _ _ _ _ _ _ _ _ REFRIG +1,750M BTU _ _ _ _ _ _ _ _ _ _ _ HEAT PUMP & AIR CONDITIONER 0-3 TONS _ HEAT PUMP & AIR CONDITIONER 3-15 TONS _ HEAT PUMP & AIR CONDITIONER 15-30 TONS _ HEAT PUMP & AIR CONDITIONER 30-50 TONS _ HEAT PUMP & AIR CONDITIONER +50 TONS _ _ VENTILATING FANS _ _ _ _ _ _ _ _ _ _ _ _ EVAPORATIVE COOLERS_ _ _ _ _ _ _ _ _ _ - TYPE I HOOD (PER 12' OR 12' PIN. OF HOOD) TYPE II HOOD____________ CLOTHES DRYER__________ RANGE_ ________ _________ GAS LOG _ _ ELSEERE)_ _ MISCELLAOUS (NOT COVERED WH NE UNLISTED GAS APPLIANCE <400,000 BTU _ _ UNLISTED GAS APPLIANCE >400,000 BTU_ _ _ USED APPLIANCE <400,000 BTU_ _ _ _ _ _ _ USED APPLIANCE >400,000 BTU_ _ _ _ _ _ _ AIR HANDLER <10,000 CFM _ _ _ _ _ _ _ _ AIR HANDLER >10,000 CFM x$10.00 = X 25.00 = X 10.00 = x 12.00 = 13 x x 1.00 - x 12.00 - x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = X 10.00 = X 10.00 = X 30.00 = x 10.00 - x 10.00 = x 10.00 = X 10.00 = x 10.00 = x 50.00 = X100.00 - x 50.00 = x100.00 = x 12.00 = X 15.00 = / /1910r) -%- - SUBTOTAL i PLUS: PROCESSING FEE + EQUALS: 'LU'1'AL YEIfMl'1' y+ NOTE: I UM T FEE IS 35.00 FEE DUE _ $ 3 01 vco SIGNATUR Spokai e C Department of Building and Safe tv West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675