1990, 12-11 Permit App: 90006719 Fireplace, Piping•
MECHANICAL PERMIT •APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: S 2103 014 -ho. et
CITY/STATE/ZIP: YOkat•
1
MAILING ADDRESS:
CONTRACTO
MAILING
01
(stre
Le
CEL NUMBER:
PHONE NUMBER: S3S- 7773 •
304 ego/Sfax-Sae:awl LAM- qqa.93
(dity/State) (Zip)
41/fa3 LICENSE NUMBER:
PHONE NUMBER: c53i---/ 78-71
ADDRESS: 59a5-Tanfr
e ne1 Wiv ofirx),
(Street) (City/State) (Zip)
MECHANICAI:SORESHEET/FEE .SCHEDULE
NUMBER X EACH
•DESCRIPTION OF UNITS UNIT = AMOUNT
'DUCTWORK:SYSTEM
;.WOODSTOW/INSERT
' GASWATER REATER
._.;HEATINGEQUIPMENT' <100
HEATIROtEQUIPMENT +100
,..PPASPIIa*[.(EA.OUTLET
REFRIGkiHxppm-',Bruy (Nor
l'Acq:HEW:RUMP,:k°"-A11-4,CONDITIONERG:t7ONSJUt
W*EATPUMPAIIUCONDITIONEW73,415'4TON
PIJMP
me & A AIR,CONDITIONER:3050t;TONS
.1.:HEATPUMP &AIRYCONDITIONER
VENTILATING- FANS .EVAPORATIVE- COOLERS - Y%• %-,
....-:TYPE:I:11100D(PER 12' OR 12': PTN;.: OFT HOOD)
TYPE II.HOOD
CLOTHES DRYER
1000 •BTU;i7.7.''...-1
:1 000 BTU• . ,•••
„ • .1
A/C OR HEAT PUMP)
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE).
UNLISTED GAS APPLIANCE <400,000 BTU
;UNLISTED GAS APPLIANCE >400,000 ZTU.
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
• --1•T":i„.
x$10.00 =
x.325.00
x 10.00 =
x 12.00 =
12.00
00 =
x 15.00 =
.x.•::A3.5.::•:0 0 ',4'77" •
00x 60:;.:
• ...A.
x 20.00
. . ,
xh25;00''.=
xic35;,.00y-:•F,
. •
X •20.00'.=
x 10.00 -=
x 50.00 '=
x 10.00 =
x 10.00 =
x 1O.00=T.
x 10.00
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
10,n)
jel
NOTE: MINI UM PERMIT FEE,IS $35.00
0CILVA'
SIGNATURE
SUBTOTAL.
$J1,00
PLUS: PROCESSING FEE
$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Spokane County Department of Building and
West 1303 Broadway Avenue , Spokane, WA 99260
Safety
(509) 456-3675