1992, 07-15 Permit App: 92005305 Mechanical Fixtures• 1-0-3 n
MECHANICAL PERMIT APPLICATION FORM
-ca0\2. e
`\ Information Worksheet
JOB STREET ADDRESS: Fe; ')/ ()C itYtc:
CITY/STATE/ZIP: SI). tc--)4 c79? PARCEL NUMBER:
- 5305
(Qc)
OWNER: O( 6 PHONE NUMBER,? ,- -
MAILING ADDRESS:
(Street)
CONTRACTOR: A_),OkY0 /7/6/2/7/ti6j
MAILING ADDRESS: 6,, .5/CZ
(City/State) (Zip)
LICENSE NUMBER: 410,(906/2/79/ C C
PHONE NUMBER:
SP() ix)i4
DESCRIPTION
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
W000$700160 :II
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWOR
GAS PIPING EA OUTLET)...
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 1O1 -500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001-1,750M S
BOILER/REFRIG +1,750M BTU
'
IR CONDITIONER 0-3 TONS :
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS :
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR COND'TIONR +50 TONS
VENTILATING FANS
TYPE i HOOD (PER 12' OR 12' PTN. OF HOOD
TYPEIIHOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHER
UNLISTED GAS APPLIANCE <400,000 BTU
LINSTED GAS APPLIANCE>400,000•
USED APPLIANCE <400,000 BTU
USED APPLIANCE>400,000 '"-
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
x 25.00 =
x10.00 =
/O..v
N.,
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x10.00 =
x 10.00 =
x10.00 =
x 1,0.00 =
x sac) =
xioo.00 =
x 50.00 =
x100.00 =
N.,
x 12.00 =
x 15.00 =
SUBTOTAL
$ ,r -,N db
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ W Z
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675