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1992, 09-25 Permit App 92008045 Gas Log-Voidf MECHANICAL PERMIT APPLICATION FORM Information Worksheet ,/QB STREE1 ADDRESS._ _12.1_22.,52 CITY/STAT UZI P: OprorTl) A))7-1/ u-)/9. OWNER: a fi-T/i/ I VI) MAILING ADDRESS:/9 '- (Street) CONTRACTOR; /06 RTA tvlsr n 77 Al MAILING ADDRIS‘P-O. BO X /3 1./4'7 (Street) /6R61U.Y)14 ?...??.L.L PARCEL NUMBER: PHONE NUMBER: (City/State) (Zip) AweLICENSE NUMBER: MuREF-71g,g2L-Tri PHONE NUMBER: efi ioe L....1t) (CltylState) (Ztp) MECHANICAL WORKSH.EET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNI1 ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/INs5ERT•:.::. GAS WATER HEATER GAS (.100,000,$T0 0140.00s : CAS EQUIPMENT 4-100,000 BTU DUCTWORK) GAS .AiPiN(EA.OUTLE1)H.: BOILER/REFRIG 1-100M BTU $01LERIREFAZ 1 0-14:500M:BTU:„ :..- BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG +1,750M BTU HEATOLIMP,AfAin CONPJTIONE14-.043 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEATO.UMp&:-AIR cONDITIPNE.RI:30tONS:s, HEAT PUMP & AR CONDITIONER 30-50 TONS HEAT PVMP.8 AIR.CONDITIONER TONS VENTILATING FANS EVAPORATIVECOOLERS .•... TYPE I HOOD (PER 12' OR 12' PTN, OF HOOD) TYPE)114006;',. . • CLOTHES DRYER : GAS LOG misptaAti449va-sr46T..COVEJFie.0, p4040-f,R UNLISTED GAS APPLIANCE <400,000 BTU ULIO.STPAa.APPLIANCE.4(4,o0o BTU: USED APPLIANCE <400,000 BTU tJSEDIPKIANCE$400991-p-t0..• AIR HANDLER <10,000 CFM A.IR'HANDLERi> 1 o;ocio CFM• . NOTE: MINIMUM PERMIT FEE IS $35.00 . • • x 10.00 4B x 25.00 x 10.00 x 12.00 x 15.00 at x 1.00 x 12.00 - x 20.00 wr x 25.00 = x 35-00 x 60.00 = x 12.0G = x 20.00 - x 25.00x = : 6350.0°0° x 10.00 = x 10.00 = x 15°100°° x0 x 10.00 x 10.00 = x 10.00 = x 10.00 la x 50.00 = x100.00 = x 50.00 = x100.00 x 12.00 = x 15.00 SUBTOTAL PLUS: PROCESSING FEE EQUALS: Tout_ PERMIT FEE DUE = AMOUNT $ oti $ 25.00 30 Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 45t3-3675