1993, 03-22 Permit App 93001664 ACMECHANIGAL PEIHNI14 APPLICATION FORM
Ir. formations Worksheet -e.-8[6
JOB STREET ADDRESS : / `7 `%/ ,
CITY/STATE/ZIP: h/42? 990*PARCEL N hBER: Z2j1 13 3151
/
OWNER: AZ. 4iN. J1 o //�� PHONE NUMBER : ,/ 0 Li %
DoC1
MAILING AD
D SS: /77/(p gQ l> °
(Street)
CONTRACTOR: ,C., Q0.40 C%'Y%af'Yt�
MAILING ADDRESS: V
(Street)
DESCRIPTION
jLke A 0. 1e qe-D i S�
(City/State),(Zip)
LICENSE NUMBER: SZ. -A2- .�?.f2- 3'9aA)
PHONE NU BER : gga - S70&S-
s� & / /'9? 99 r
(ity/State) (Zip)
JIIIIIMEMMINIMMEIMINMIENNiffewrimmomEgit
MECHANICAL WORKSH_EET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100, 000 ETU
GAS PIPING (1 - -4 OUTLETS)
GAS PIPING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS _
HEAT PUMP & AIR CONDITIONER 15-30 TONS _
HEAT PUMP & AIR CONDITIONER 30-50 TONS _
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS_ _ _ _ _ _ _
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)_
UNLISTED GAS APPLIANCE <400,000 BT
UNLISTED GAS APPLIANCEU_
>400,000 BTU_
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,00 0 CFM
AIR HANDLER >10,000 CFM
r
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 1».$ =
x - -- -
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 =
x 60.00 =
x 10.00 =
x 10.00 =
Y 50.00 =
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 =
/Q.Do
NOTE:
SIGNATURE
FEE IS -35.00
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
Spoka ► e C L>*r Department of Building and Safety •
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
$ 25.00
=.$37-0-