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1993, 05-27 Permit App: 93004012 Gas Log, Piping n -t MECHANICAL PERMIT APPLICATION FORM q qo,- Q Ve e"c c7- l 4D Information Worksheet JOB STREET ADDRESS: . 14//e041 /o2 1-4 3 CITY/STATE/ZIP: V.-(AAALJ , k)' `3r6 0.3 1 PARCEL NUMBER: OWNER: �''� �,rC,t� kiaiL t.j_ PHONE NUMBER: .9-eq LvaSOS MAILING ADDRESS: U EP- (Street) (City/State) (Zip) CONTRACTOR: EP- ) C r4 DP"iJ C... rif Fre LICENSE NUMBER: Fir- i co (:'L. ! !=% D V( PHONE NUMBER: (5C;ai) L J(r.- " l 1 MAILING ADDRESS: E 131 n .:54;) Ji .F �c .r:I/0' LL).-9 792c;67 (Street) (City/State) (Zip) ._ MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = . ............ WO,ODSTOVEJINSERl :;: :::::>;. x 25.00 = GAS WATER HEATER x 10.00 = GAS EQUIPMENT<100,000 BTU(INCLfDES x 12.00 = GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = • SAS_PIPING(EA_OUTLET -----..:'=: ..::;. ( x 1.00 = f-OD • - BOILER/REFRIG 1-100M BTU -.- x 12.00 = - BOILEAIAEFRIG 101 S00M BT11 ><-::`';.; x 20.00 BOILER/REFRIG 501-1,000M BTU -.----- • x 25.00 BOILERIREFRIG 1 0001--1,750M BTt '<=:=:=:. ------ x 35.00 = - BOILER/REFRIG+1,750M BTU- x 60.00 IEA' PUMP&AIR CONDITIONER A-3 TONS:::. ::.::.`:,: x 12.00 HEAT PUMP &AIR CONDITIONER 3-15 TONS- - -- x 20.00 = HEAT PUMP AIR CONDITIONER 1 30 TONS x 25.00 - - - HEAT PUMP &AIR CONDITIONER 30-50 TONS -- • x 35.00 = HEAT'PUMP&AIR CONDITIONEP fa.0 TONS'` '.;: . :. .: x 60.00 = VENTILATING FANS - x 10.00 = EVAPORATIVE COOLERS:':'.::: :::S:,:.< ` s;::>.= ::i»:::=-i::<->> x 10.00 = TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) - - x 50.00 = TYPE 11 HOOD x 10.00 = CLOTHES DRYER x 10.00 = � NGE x10.00 = GAS LOG ( x 10.00 = /0 • 06 MISCELLANEOUS(NOT:COVERED ELSEWtHERE x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTED'GAS APPLIANCE>400,000 BTU x100.00= USED APPLIANCE<400,000 BTU x 50.00 - USED APPLIANCE x400,000 BTU ' - x100.00= AIR HANDLER<10,000 CFM x 12.00 = AIR HANDLER>10,000::CFM x 15.00 = SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT 6 62f FEE DUE = $ -) SIGNATURE Spokane County Division of Buildings