1991, 11-25 Permit App: 91008189 Mechanical FixturesMECHANICAL,PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:_______
CITY/STATE/Z1P:
OWNER: 9,4.-/-r --tv/vo/(5
MAILING ADDRESS: ,
PARCEL NUMBER:
PHONE NUMBER: 9* -2" 7
Street)
(City/State) (Zip)
7.0NTRACTOR: C LICENSE NUMBER:A/k7 FL /1/? A.,? 3 K
HONE NUMBER: 79'
—
(Zip)
MAILING ADDRESS:
DESCRIPTION
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
wp.00VPM:t4g0111111r7111011111104
GAS WATER HEATER............. .......
GAS EqMENT<iop000
GAS EQUIPMENT +100,000 BTU DUCTWORK)
04fitrtariikkOMMIITATaMIFINE
BOILER/REFRIG 1-100M BTU
OLCINEEKI:01„ 8 8 }4 /gglj
BOILER/REFRIG 501-1,000M BTU..
•
Itrigraggi
BOILER/REFRIG +1,750M BTU,
HEAT MRE Wirift7 ,N (":"6k1,-ar,CV 44,
HEAT PUMP & AIR CONDITIONER 3-15 TONS
H EAatNE:0070.:§PMERBIAWP
HEAT PUMP & AIR CONDITIONER 30-50 TONS.
H jailATERREME
VENTILATING FANS
MTIVredOttbsiir 74* >,s4,*(,t
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) •
TY?,
CLOTH ES DRYER
GAS LOG
MISC.- • • • •
..
UNLISTED GAS APPLIANCE <400,000 BTU ...
ULINSTED
USED APPLIANCE <400,000 BTU
USED • •
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000 CFM
7
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
i
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 12.00 = -
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x10.00 =
x 10.00 =
x 50.00 =
x io.00 =
x to.00 =
x to.00 =
x io.00 =
x io.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
r i
1 -
.
•
L_
, . .. .
I i
f
•
I
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings