1992, 10-19 Permit App: 92009086 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: ,5 Q O Li 3(a ncQ
CITY/STATE/ZIP: 5 pv(iwv f (.J A qcr 774) PARCEL NUMBER:
OWNER: Pon. IM' C'CAC1X Q PHONE NUMBER: 4 -cOYO
MAILING ADDRESS: Pk -4N_ '-'42
(Stree't)/' (City/State)
CONTRACTOR: /4-D (< i d m" Cif- S, LICENSE NUMBER: J/O// / /14 /7 3.r
PHONE NUMBER: J- 47, /
MAILING ADDRESS: Cie( gn I4ccO JQS
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
(Zip)
DESCRIPTION
- PP)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
to EQU(f't til OMNIg HTU INCI CO
GAS EQUIPMENT+100,000 BTU DUCTWORK)
„AS PIPING.(4AAUT.::.: <: nsw<Y9
BOILER/REFRIG 17100M BTU
talitainte
BOILER/REFRIG 501-1,000M BTU
Ett p11,:I qlaIG (,,AOU „r,y50M.>3T
BOILER/REFRIG +1,750M BTU
£HEAT f'gin AIR CONb Og d
HEAT PUMP & AIR CONDITIONER 3-15 TONS
II EAT P(!N[F'; Atli iONO T1 I R.E5 3 r
HEAT PUMP & AIR CONDITIONER 30-50 TONS.:':
illia Pt1MF? Alf;: pNpl!iQNER+SU,TONS
VENTILATING. FANS •
R NODI A '1VE C,, QLE S
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
`TYPE tt HOG3d .
CLOTHES DRYER
GAS LOG
rMISCEtiANtgS (N1.
QT COVPRED ELSEWHER
UNLISTED GAS APPLIANCE <400,000I BTU
itf iNSTEDAGAS APpltANCE '40O1OUN NTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE>A00,000�I3TU :.
AIR HANDLER <10,000 CFM
AIRHANDLERYttl,000.CFM . ;...
/
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
x60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35:00 =
x60.00 =
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
/a , -
s
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE `ta
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ : 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
Co