1992, 07-15 Permit App: 92005308 Mechanical FixturesJOB STREET ADDRESS: _
CITY/STATE/ZIP: /) • &i9 `9% � o�
OWNER:(Jf(`Y
MAILING ADDRESS: C. J4,93 / I3OG'ee/6:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
1 fiFyE
n (Street)
CONTRACTOR: l v01((I) /i /4)(/7
MAILING ADDRESS: -r,1-743-7-,,E0,
DESCRIPTION
(Street)
0a-5302).
PARCEL NUMBER:
PHONE NUMBER: %p1/40
(City/State) (Zip)
LICENSE NUMBER:0>2Cj)f)/TY
PHONE NUMBERS ` - (//q76-
51)(
5/)( 1 924,9_,
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
r0STOVIINSERr... ......
GAS WATER HEATER
GAS EQUIPMENT <i00, .B U QNCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BQILE tIREFF IG.. 01-500M BTu
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG` 1,0001 1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AER CONDm0N
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP &. IR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE HO
CLOTHES DRYER
GAS LOG
MISCELLANEOUS NQT COVERED El SEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTER +SAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
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 =
x1,0:00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
X 42
v
/ 68
SUBTOTAL
$ //, W.)
+ $ 25.00
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
3,g
=$
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675