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1992, 08-18 Permit App: 92006532 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM Information Worksheet 'JOB STREET ADDRESS: D�\.� CITY/STATE/ZIP: D��.�`M� �G \�a\� PARCEL NUMBER: y5;s7.2 - p,0‘ OWNER: \�`^^ C���S��s' PHONE NUMBER: MAILING ADDRESS: 40-�--sz. o. -S (Street) (City/State) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Zip) (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) 4 El..... . ....................................................................................................................... . GAS WATER HEATER GAS QU1PM NT'' 00, 00 GAS EQUIPMENT +100,000 BTU DUCTWORK) ......................................................................................................... GAS: PIPING: EA.OUTI BOILER/REFRIG 1-100M BTU t"a.0...50. .......... ............................................................................................... . ...................................................... ............. ..................... .................. BOILER/REFRIG 501-1,000M BTU BOILfsR/REFRIG 1. 0001'-1' 750M BTU>:; ................................................................................................................................ . BOILER/REFRIG +1,750M BTU H EAT;PUMP: & AtI CON[ 1TION ER: 0-3 'TONS: :: .. ................................................................................................................................. . ........................................................................................................................................ HEAT PUMP & AIR CONDITIONER 3-15 TONS ..................................................................................................... HEAT PUMP &` AU `CON1D#TION ER" 15.-30 TO HEAT PUMP & AIR CONDITIONER 30-50 TONS .................................................................................................. 'H EAT PUMP .& AIR' CONDITIONER +50 .TO,I VENTILATING FANS .............................................................................. EVAP.ORATIV.ECOO.LERS:: .............................................................................. .................................................................................... TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) ........................... TYRE:A:HO .... CLOTHES DRYER .................................................................... .......................................... GAS LOG ......................................................................................................................... MISCELLANOUS (NOT COVEREDD LSEWH RE UNLISTED GAS APPLIANCE <400,000 BTU ...................... ...................................................... ULINSTED G.ASAPPLIANCE>400000 BTU USED APPLIANCE <400,000 BTU .......................................................................... ......................................................................... USED APPLIANCE:>400;000'BTIJ AIR HANDLER <10,000 CFM AIR HANDLER>10000;:C NOTE: MINIMUM PERMIT FEE IS $35.00 (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT 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 = 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 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = l 1( \� SUBTOTAL $ X 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