1992, 09-15 Permit App: 92007603 Mechanical FixturesJOB STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM S.lrtteiS
• ..J,nformation Worksheet
.q3-OCITY/STATE/ZIP: c yPARCEL NUMBER. 3 5 Z.2-/-3-
OWNER:
WNER: kiii -AC C /t9 PHONE NUMBER:
MAILING ADDRESS'
(Street)/ (City/State) (Zip)
CONTRACTOR: /2GCe o/t G LICENSE NUMBER: "-ICCL¢/-��/•53
/ PHONE NUMBER: `6 7 t- '& Ye_ (--
MAILING
MAILING ADDRESS: _Cr _2 %l y" J
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT..;iis:,;:, :>`;:;:.:.c:i:.:r "::
GAS WATER HEATER
..:..:...... ....
GAS-EQUIPMENT.{100,000, BTU: (INC LU,DESi',:_
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS .PIPING' (EA`OUTLETi ;.:..: r.'
BOILER/REFRIG 1-100M BTU
E0I1,ER/REFRIG,10 500M BTU"'; E
BOILER/REFRIG 501-1,000M BTU
•
BOILER/REFMIG`1, 0001;-1,750M;BTU` ::.` ^a
BOILER/REFRIG +1,750M BTU
HAT PUMP & AIR GONDITIONER 0-3 TONS::
HEAT PUMP & AIR CONDITIONER 3-15 TONS -
;HEATPUMP&'AIR`CONDITIONER"15-30TONS::
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT.PUMP:.&AIEi;CONpITIONER;+50,TONS[`:
VENTILATING FANS
EVAPORATIVE 000L FiS.'' _' < i
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE ILHOO.D":.
.............
CLOTHES DRYER
GAS LOG
MISCELLANEOUS;'(NOTCOVERED ;ELSEWHERE:
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APDL IANCE>400;000:BTU .-. :-;
USED APPLIANCE <400,000 BTU
USED 'APP LI ANC E.>40;0;000;BTU
AIR HANDLER <10,000 CFM
AIR HANDLER;>10000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x12.00 =
x 15.00 =
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 =
x 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 =
/
/0 -
/
/ Z -
2_
Z
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
DUE
2/9FEE
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675