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1993, 02-01 Permit App 93000531 Wtr HtrMECHANICAL PERMIT APPLICATION FORM q Infer ation Worksheet JOB STREET ADDRESS: / / D A E • / - ' ,v CITY/STATE/ IP: GIi? & �! t ) A-. 99r� / (0 PARCEL NUMBER: 4J 53 . 6 / 040 OWNER: P14 PHONE NUMBER: 9,-9-/ 02/4- MAILING ADDRESS: 49-0) `e- (Street) CONTRACTOR: A% • 0) . {�E -77N6 e A/&__. MAILING ADDRESS:? - gL / 3 '/' 7 (Street) DESCRIPTION (City/State) (ZIp) LICENSE NUMBER: n) to R I; r- >1 c / gJ q PHONE NUMBER: uL) i4. 9(3/3 1 City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) W000STOVE/INSERr GAS WATER HEATER :GAS.EQUIPMENT <100,000.'BTU (INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING (IRA OUTLET) ` BOILER/REFRIG 1-100M BTU w.w, ;BOILER/REFRIG 1017500M ETU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1,0901.1,7S0M,S1 BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONER'0 O TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT:PUMP &:AIR CONDITIONER`15-30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PUMP 4AIR GONOlTIONBR #50 TONS VENTILATING FANS EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE 11 H000 CLOTHES DRYER iNGF. GAS LOG NUMBER OF UNITS X EACH UNIT I,ISCEL ANEOUS (MOT CAVBREQ ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANCE�4p0 000 BTU USED APPLIANCE <400,000 BTU USED APPI IANCE >400,000'BTU "`} AIR HANDLER <10,000 CFM AIR HANDLER >10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE /11,cuokyc SUBTOTAL x 10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 = x 25.00 = x35.00 = x60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 - x 60.00 = x 10.00 = x10.00 - x50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 - x 12.00 = x 15.00 = = AMOUNT 40 $ // 1)0 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ 00 Spokane County Division of Buildings West 1303 Brnariwav Ot/nn110 %A/A nnnnn .r