1992, 09-29 Permit App: 92008187 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
t , Information Worksheet
JOB STREET ADDRESS: / 1/ . 4D�y o 7�} a Lu 1 J !Eo 4 b
CITY/STATE/ZIP K ��t'KAN € be) 1921 o
OWNER: 2 f, EN DP 0,0 OCp.;7-
MAILING
;T
MAILING ADDRESS: c5/4/09E
PARCEL NUMBER:
PHONE NUMBER:
(Street)
CONTRACTOR: Tl 1 Z ' 647-a6 ?/3//:
MAILING ADDRESS: ?D. ao X /.317/4/? GL) 4
(City/State)
(City/State) (Zip)
LICENSE NUMBER: A) -) '7
PHONE NUMBER:
$#/q9
(Zip)
DESCRIPTION
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
.....................................................................................................................
W� OD. T....V INSERT
OO...5...4 El ....
GAS WATER HEATER
GAS QUIPM
IBTONCc.0„.
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
..........................
BOlLERIR FRIG.»1.:x0001;-1,750M.BTU>:::> < < < >
BOILER/REFRIG +1,750M BTU
.............................................
..............................................................................................................
H ATP MP<S AIR ONDITION:ER. '04T
HEAT PUMP & AIR CONDITIONER 3-15 TONS
..H...EAT<PU P> 'AIR<GOND TIONER' 5-30::TON$
HEAT PUMP & AIR CONDITIONER 30-50 TONS
A: ;:> `::A..:.;:. Dl..>I:.::..... R 450:__..:..::,..:.:>
VENTILATING FANS
EVAP :RAT:IVE>000LER
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
.........................................
GAS LOG
:::...........
............................................
.........................................
MISCELLi4NEOU$ (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
11LINSTSf ::GASAPPLIANCE:>400,0000
USED APPLIANCE <400,000 BTU
............................................................................. .........................
USED APPLIANCE: ... .0BT
AIR HANDLER <10,000 CFM
AI HANDL$...:. R>t.0,;0000:00:C:::..::.<:;<;<::>::;::>::>:::::>
, f=M>::»>>>>:;::::::'::::::>
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
A-- 2Y) l k
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 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
J
/O,OO
/a.o0
fav
SUBTOTAL
$4,00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 4,79.e
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675