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1994, 07-08 Permit App 94006327 Wtr HtrMECHANICAL PERMIT APPLICATION FORM Inform,h Worksheet JOB STREET ADDRESS: 'I-- CITY/STATE/ZIP: ”,4010 PARCEL NUMBER: OWNER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: ) LICENSE NUMBER:10e, ?4i / / PHONE NUMBER: 5- 7_)7--jii? (Q32-7 MAILING ADDRESS: _5* _? , rQ_ (Street) (Cify/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) . . ......... wpory67,Q.VqMg.M ga GAS WATER HEATER ::GAS.::(;10)PMENT:i0.00;00.0$T.07(I.00(3mE GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU BOILER/REFRIG 501-1,000M BTU BOILER/REFRIGi;OXii41756M 'BTU BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONER 0-3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS HEATPOMP::&:*04::cdootrioNER.1.54107TO HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT VENTILATING FANS EV4PcMATP;ItCQOLERS• TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPEIIHOOD CLOTHES DRYER RAIGE • . GAS LOG MSCELLANEbUS(Ncr COVERED ELSEV'H ERE UNLISTED GAS APPLIANCE <400,000 BTU IJLINSTED.GAS:AppLIANCE*00.;000 BTU USED APPLIANCE <400,000 BTU USEaAPPLIANCE'*00..;000.BIU • AIR HANDLER <10,000 CFM 'AIR' NOTE: MINIMUM PERMIT FEE IS $35.00 NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x25.00 mg / x 10.00 x 12.00 = x 15.00 = x too = 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 = x 10.00 = x50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 1.0.00 = x ROO = x100.00 = x50.00 = x100.00 = x 12.00 = • 4 • x 15.00 = SUBTOTAL $ /0. 0 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =S3b.011.) SIGNATURE Spokane County Division of Buildings West 13i °way Avenue Spokane, WA 99260 (509) 456-3675