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1994, 04-06 Permit App 94002839 Furnace, Wtr HtrJOB STREET ADDRESS: CITY/STATE/ZIP:.5pe OWNER: C-_,P02 r MECHANICAL PERiviri APPLICATION FORM Information Worksheet / �r� n q� a8`39 3o57 %y0/,9 PARCEL NUMBER: PHONE NUMBER: -- 9 MAILING ADDRESS: • (Street) ' _(City/State) (Zip) CONTRACTOR: t) fry-r-n Ii...P-itt- ,i LICENSE NUMBER: NI, Pco HA 07 6 41 -�-- 1 PHONE NUMBER:. 3.1- 4/ 75 MAILING ADDRESS: F, .7 / 0 3 l ��� XJJ_-A,r,__ /9%C z,g,L,L (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQUIPMENT +100,000 BTU DUCTWORK) • BOILER/REFRIG 1-100M BTU '.I.E .::.::.EF BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG +1,750M BTU GEA,T PULP & AER CONDITEC ER t-3 ONS HEAT PUMP & AIR CONDITIONER 3-15 TONS : .....:<.. HEAT PUMP & AiP.COND TIONEl 15-30 TOWS. HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PU P & AIR COi D�T1ONER +50 TONS VENTILATING FANS iATIVE::„..O.LEA,:..`<»<< TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) .................................................................................................................... CLOTHES DRYER GAS LOG " i GELLANEO S'(NO G• :•.g6ED EL SEWNERI UNLISTED GAS APPLIANCE <400,000 BTU USED APPLIANCE <400,000 BTU ......................................................... . AIR HANDLER <10,000 CFM ;HA1��irER lf�l NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE ./z„, /4g--611- NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00 = x10.00 = x12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x25.00 = x 35.00 = x 60.00 = x 10.00 = x10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.b0 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = / J0,00 /5 on �, (➢c5 m� • SUBTOTAL $ , 5 h/, o 0 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE �/ =$ "l 0- OG Spokane County Division of Buildings West 1303 I Avenue Spokane, WA 99260 (509) 456-3675