1993, 11-03 Permit App: 93010392 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Inpfmation Workshop
JOB STREET ADDRESS: r/6.
0 F- _Et- I �-
CITY/STAT ZIP• Sirx,Hct.we6 . l 1c9- /c PARC UMBER:
OWNER: A -v k &- . r t. e '6i &Le_ .- PHONE NUMBER:
MAILING ADDRESS:
CONTRACTOR:
l
93-lo3g2,
9(; - 66
)de ;ti
MAILING ADDRESO & BX3 / /9
(Street)
DESCRIPTION
(City/State) (Zip)
LICENSE NUMBER: NOR x';11-1 /4 o 7a Jo
--PHONE NUMBER: 9oZ;?- �D8'
0Aa---t-E) GOO 9
(CIty/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
.::.........UM::
GAS WATER HEATER
•ate. (1J1•8 �> X000 UTU(INQLUD.ES ><»
GAS EQUIPMENT +100,000 BTU DUCTWORK)
f(�
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
thafriNgAttakaair
HEAT PUMP & AIR CONDITIONER 3-15 TONS
'"stAltaNtkilkONEA1'I5 O TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
4
T MO R>GQ.NDI 'IO R s5o T NS
VENTILATING FANS
TYPE I HOOD PER 12' OR 12' PTN. OF HOOD)
`GJ .. .. � :__......,.. c.,%"s:?i;,,:. _::k-.'.�X":•1r+��T.�:;Y£$;:.<, i�i8$.:.'•i3•tt°?:L':5.?
s)4
CLOTHES DRYER
isx<
GAS LOG
r, Vii: R 5 ;1;.:.`3,i K• `+%,'.YG: "�t�' ;:}�•'''•
•
1. ' '. taqVg. E LSk1fVHERE<x
UNUSTED GAS APPLIANCE <400,000 BTU
USED APPUANCE <400,000 BTU
AIR HANDLER <10,000 CFM
NOTE MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00e
x10.00 =
x12.00 =
j.•D0
x 15.00 -
x 1.00 -
___
/, L)0 _.
/
x 12.00 -
x 20.00 m
x 25.00 =
x35.00 =
x 60.00 m
x12.00=
x 20.00 =
x 25.00 -
x 35.00 -
x60.00 =
x 10.00 =
x10.00 -
x50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x10.00 =
x 50.00 -
X100.00 =
x 50.00 -
x100.00 u
/
/a.00
x 12.00 =
x 15.00 e
SUBTOTAL
$ __,?56D
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
a56-b.tC
Spokane County Division of Buildings
West )QL&Broadway Avonno Snokann. WA 9g2(10 tralO► A';r: 'III 7r.