1991, 08-29 Permit App: 91005429 AC A
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Q Information Worksheet
JOB STREET ADDRESS: 1 0%----D 6 r .
CITY/STATE/ZIP: --PARCEL:.-LIMBER:
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&NOR:
PHONE NUMBER:
MAILING ADDRESS: ,
(Street)
(City/State) (Zip)
CONTRACTOR: CENSE NUMBER: g 1)-'vr- CW
PHONE NUMBER: %I2L:•
MAILING ADDRESS: IL kt 6 q�'C'?Z 4
(Street) (Cit /State) (Zip)
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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 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4.00 =
GAS PIING (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 _ _ t x 12.00 = tntla
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 $ Li 4
;
*,3 PLUS .PROCESSIIfq w 25* . '
;M AMPS TOTAL P #
NOTEr e r.UM PERMIT
: � ,
(®� FERC IS $35 QC :�.
n , SIGNATURE' 4 � * r � � ,''
0 �" r� ��.,. :,..fes � rr+'. r= 4 n' y
4.7
t 1303 . I hen* Spokane �= 3 t,a , F
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