1992, 04-07 Permit App: 92002236 Mechanical FixturesJOB STREET ADDRESS:
CITY/STATE/ZI
OWNER: < I el
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
(A/A .
e 57' /7--)
PARCEL NUMBER:
PHONE NUMBER:
c-/- 97 3..e
MAILING ADDRESS: 1 -
(Zip)
/170A-- e 6-)
5-3 --‘7-3c/s---
(Street)
CONTRACTOR: (1) IG101 O /7 (-71 1'V e
MAILING ADDRESS:
(Street)
DESCRIPTION
(City/State)
LICENSE NUMBER:
PHONE NUMBER:
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER WATER HEATER
GAS QU1PMENT <100,000 BTIJ (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILERIREFFIIG 1,0001-1 ,750M B
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR GONDITIONER 0-3 TONSHEAT PUMP & AIR CONDITIONER 3-15 TONS
HEATPUMP & AIR GONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AtR GONDITIONER +50 TONS
VENTILATING FANS
TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE 11HOOD
CLOTHES DRYER
GAS LOG
MISCELLANEOUS (NOTCOVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
IJLINSTED GAS APPLIANCE •'•• >400,000 '
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 DTU
AIR HANDLER <10,000 CFM...
AIR HANDLER >10,000 CFM
NOTE: MINIMUM PE MIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
x 25.00 =
=
x12.00 =
x15.00 =
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 =
x10.00 =
x10.00 =
x 50.00 =
x10.00 =
x10.00 =
x10.00 =
x10.00 =
x10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
Ix10.00
6-
/2-- ---
SUBTOTAL
$ 2T2. -
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=s I/16e
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675