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1993, 02-08 Permit App 93000698 Htg EquipMECHANICAL PERMIT APPLICATION FORM J r / Information Worksheet JOB STREET ADDRESS: 1 ! q0(0 - 1_S/- CITY/STATE/ZIP: L St70 OWNER: 47 Our, f'C MAILING ADDRESS: IL1 /0 &O/ui ('2 -` (Street) CONTRACTOR: /1 /b 7/D V� 1;7 MAILING ADDRESS: P ; rj/6 j at/J/1- (Street) DESCRIPTION PARCEL NUMBER: PHONE NUMBER: 996, S .3C7 9z7a (City/State) (Zip) LICENSE NUMBER: A.)0/2 YJ (4 j9/ ?(")/Z.Z PHONE NUMBER: (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WO D T V GAS WATER HEATER GAS :EQUIP MENT <100,000 BTU .(INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING :(EA. OUTLET) BOILER/REFRIG 1-100M BTU BOlLER/REFRIG 101-500M BTU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG1 0001.-1.750M BTU. BOILER/REFRIG +1,750M BTU HEAT.PUMP & AIP CONDITIONER 0 3;TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT.P,UMP..;&;:AIR.PONNTION01.iiq4apt0t HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT. PUMP &:A!R CONDITIONER +50;TONS! VENTILATING FANS EVAPORATI`JE'COOLERS .,............:: TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE II:HOOD ....:..........:.....:>::; CLOTHES DRYER RANG:.: GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTEO GAS APPLIANCE 00 000'BTU USED APPLIANCE <400,000 BTU USEDAPPLIANCE >400,000. BTU AIR HANDLER <10,000 CFM AIR HANDLER>10,000 CFM NOTE: MINIMUM PERMIT FEE IS S35.00 NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x1.00 = x 12.00 = x 20.00 = x 25.00 = x35.00 = x 60.00 = x 12.00 = x 20.00 = x25.00 = x 35.00 = x60.00 = x 10.00 = x,0.00 = x 50.00 = -�; f ,a , ‹IL. /,tr) x 10.00 = . x 10.00 = x 10.00 = x 10.00 = x 1,0.00 = x 50.b0 = x100.00 = x 50.00 = x100.00 = x12.00 = x 15.00 = SUBTOTAL $ / 5< 0Z PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 3Ya t SIGNATURE_�� /� Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675