1992, 07-01 Permit App: 92004904 Mechanical Fixtures:J .'
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: /'4 • 1 So "D Qe SSl e. en' •
CITY/STATE/ZIP: SynY. L)� C7 9 a I'D\ PARCEL NUMBER:
OWNER: I %no rh ✓e2ennor V PHONE NUMBER: 472 t -g,?5cf
MAILING ADDRESS: SG w r
(Street) (City/State) (Zip)
CONTRACTOR: j-rck' ICJ ',,? f ti ,!* FvE LICENSE NUMBER: t- =: !(C '•(' i' 3
PHONE NUMBER: (50(1) 4nc-- " `i 1 i
MAILING ADDRESS: ri_ I is6S--; .0 e ..•. it 4.--i/to clef cc-
(City/State) (Zip)
DESCRIPTION
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT:2.. ::'
GAS WATER HEATER
GAS,EQUIPMENT<100,000B.TU:_(INCLUDES_ :: :i-
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING. cA OUTL -
1
BOILER/REFRIG 1-100M BTU = - -- -
BOlLE#?IREFFttG.701-500M.OTU.
BOILER/REFRIG 501-1,000M BTU -
BOILERrREFRIG=1 0001-1 750M BTU _:'
• BOILER/REFRIG +1,750MBTU.'": ' :t
HEAT PUMP:flIR.COND.ITIONER 0 3 TONS --
HEAT PUMP & AIR CONDITIONER 3-15 TONS--- -
HEAT.P.UMP.,&''AIR_CONDITIONER>15"-30
HEAT PUMP & AIR CONDITIONER 30-50 TONS
;HEAT:P.UMP'&`Ala CONDI'TIONE .i-50TONS.„
VENTILATING FANS - - - .
=_VAPOZATIVECOOLERS•-
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
-_TYPE II;HOOD ;::.
CLOTHES DRYER
GAS LOG
=rrt!RCE!`i_AN=OUR: NOT:COVERED}ELSEWHERE
tINL!STED G7,5 APF_IAK = 40100,0 ETU
USED APPLIANCE <400,000 E i LU
.USE _ ,PPL N -CE.:.. ...0,00.....
D'APP IAh„->OOOt30BTU:..:':°°_,:;_-- ':.';:. .... .
AIR HANDLER <10,000 CFM
AiR HANDL=R>10,000 C=P.4 "
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 =-
x 35.00 = .-
x 60.00
x60.00 =
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 =
,.1n00 =
53.0C._
.:C =
50.00 =
x100.00 =
x 12.00 =
x 15.00 =
F=RMI F_ "...QC
2,0t
!EQUALS: TOTAL AL PERMI l
-_E DUE
y7r co
SIGNATURE
Spokane County Division of Buildings
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