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1992, 09-21 Permit App 92007874 Htg EquipMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: /- // ,Q 0 CITY/STATE/ZIP: Spr)f\--ct e , Le)A c/ ia.Ofn PARCEL NUMBER: OWNER: )36 b Oe MAILING ADDRESS: (Street) CONTRACTOR: D U o+1- 5 t�ekt+i vv r%<loyd. PHONE NUMBER: qa8 - S MAILING ADDRESS: 'P 2 c ?l //4 c? (Street) DESCRIPTION (City/State) (Zip)-,i7yS LICENSE NUMBER: LL_3(-t ATTNC. l 0l G4i PHONE NUMBER: 3'S - SpO a11Q. )/J )11 pia[ (City/State) - (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/INSFBT' .; GAS WATER HEATER GAS; EQUIPMENT <100,000I3TU,(INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) ;GAS PIPING (EA OUTLET`) BOILER/REFRIG 1-100M BTU 'l3OILER/I ErnIG <:101 500M 13T BOILER/REFRIG 501-1,000M BTU BOILED/REFR.IG 1,0001 BOILER/REFRIG +1,750M BTU .HEAT''PUMP C AIE' COt1 I FIONER 0' `3 TONS HEAT PUMP & AIR CONUI 1 IONER 3-15 TONS :'HEAT PUMP `& AIR,CONDITIONER 15=30 TANS HEAT PUMP & AIR CONDITIONER 30-50 TONS >HEAT:PUMP & AIR,+CONDITIQNER +50 TONS:.. : : VENTILATING FANS :EVAPORA711lE COOLEAS • TYPE I HOOD (PER 12' OR 12' PIN. OF E 10013) TYPEl1 HOOD • • CLOTHES DRYER ............... �:1y:•: };},tiff:. { :::v.{ '+;i}:::i:- i:Li:;j;:: :: ::.};:i.i:::S.ii:i:: N G E �}.}:,�;.,,�<«.:{<, Y.::9:i .i:v+l.: . } f j:tt:i:.r,•;v �: �?i.4+`'i;;Y:'I•.,y�::r.:.:-::..0': •;.i} :� •: i):c ::... • .......:::.......J:?'4.:: �. } ::•. k::..v:: hvn1.�{ 4.:: ii.' •: Yrtiv': j:�:Y::-}4:: i#,G.}{.{:':i:;:.Li•.�}n�••,i::.i:::v::...:.:::• GAS LOG .............................. . . . ii.M ISCELLANEOUS (NOT COVERED ELSEWHF UNLISTED GAS APPLIANCE <400,000 BTU ULINS.TED GAS APPLIANCE >400,000,BT:IJ USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 AIR HANDLER <10,000 CFM AIR HANDLER >10,000 CAM • NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x10.00= /0.00 x 12.00 = l x 15.00 = /s--, 0 o ,, 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 = x60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = o7. O O x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ .Q7- 00 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ Sc1.00 Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675