1992, 08-19 Permit App: 92006600 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: - 3 0) %O6J Q /:_c/-1
X30
CITY/STATE/ZIP: S/bx/44/ GJ/9. J>.?06 PARCEL NUMBER:
OWNER: CO L GnJ C y PHONE NUMBER: 1.2 `/- T'o S`
MAILING ADDRESS: S. T0/ 7 /TOCc)yp /S "4- P -e06
(Street) (City/State)
(Zip)
CONTRACTOR: '09 7-/04v/9 - CN///7/1/t/ S'( -__LICENSE NUMBER: I/4 % /0 /oo K q
PHONE NUMBER: I as -0260C)
MAILING ADDRESS: C %8/' /Tie() ' / uhe9 Y PA' 1, )4 99 O
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
V.V..QQ.psToy.:g104.$EIT:>
.................................................................................................. .
GAS WATER HEATER
......................................................................................................
;GAS f'Mt=t 100,4'('U (INCLU0
GAS EQUIPMENT +100,000 BTU DUCTWORK)
...............................................................................
.............................................................................. .. ........................
BOILER/REFRIG 1-100M BTU
.................................................................................................................
.............................................................................................................
..............................................................................................................
BOILER/REFRIG 501-1,000M BTU
BO:ILERFREFRIG 1:,0001 1 750M STU: :»
BOILER/REFRIG +1,750M BTU
HEAT<PUMP &; AIR CONDITIONER` 0-3
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AD GONt TION ER 5- 0 TONS<
...............................................................................................................
...................................................................................................................
HEAT PUMP & AIR CONDITIONER 30-50 TONS
.............................................................................................................
HEAT::PUMP:&'ALf CO It 1TION.ER +5Q:7'QI�IS
.............................................................................................................
VENTILATING FANS
EVAP.................................................................................................................
....................................................................................................................
.....................................................................................................................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
..................................................................................................................... .
RAN
GAS LOG
M.ISCELLAI E'*C US:. NOT'>GOVERED ELSEWHEF 1= << >> <:
UNLISTED GAS APPLIANCE <400,000 BTU
.................................................................................. .............................. .
ULIN TEI)' A >APPLIAN E>40 :,
...........................................................................................:
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
...................................................................................................................
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE G✓ Ong
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
(Zip)
N moGSA- obK 9
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
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 =
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 =
/
/
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
y
= $ jU .,c5::