1993, 03-22 Permit App: 93001656 Mechanical Fixturesq 3 . IbS� PJ felVec,C
S/C)�, MECHANICAL PERMIT APPLICATION FORM
J o \\ )�Information Worksheet
JOB STREET ADDRESS: 1 Y -1-2-2- CA4 A! JQQ
PARCEL NUMBER: 4,5 1 (n ) • I I Z -
((A
CITY/STATE/ZIP: S:PDF ASC / to A
OWNER: rCA,tc_i S L) AeF2� Al
MAILING ADDRESS: ci &' *G
pp (Sitreet) ,/� (City/State)
CONTRACTOR: t(ki Ol Wt( Wt{- & JJ Lj, LICENSE NUMBER:
PHONE NUMBER:
PHONE NUMBER:
q2y- a sS 3
(Zip)
Ro (1 x F4 Q (2,) 55
MAILING ADDRESS: 5 C5 g2- VA.U12PL/A CA 5er1C'1 Wim' `Igo°ci
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
- (zp)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
iW000STOVE1(Ngelik. ;
GAS WATER HEATER
GAS EQUIPMENT <10'0,000 BTU (INCLU E
GAS EQUIPMENT+100,000 BTU DUCTWORK) •
GAS PIPING (EA OUTLEIj
BOILER/REFRIG•1-100M BTU
&B: iLEIIREFRI
BOILER/REFRIG 501-1,000M,BTU-
BOILERJ EFRIG,0,004T „1,750M_BT
BOILER/REFRIG +1,750M BTU
;HEATPUMPM&AIR GOND ONER,0-3NT(
HEAT PUMP & AIR CONDITIONER 3-15 TONS
ligfelit&WIKNO.Ottagilaa
HEAT PUMP & AIR CONDITIONER 30-50 TONS :
HEAT ENOS teingnitia.I
VENTILATING FANS
1041014124a1„,
TYPE IHOOD (PER•12' OR 12' PTN.IOF HOOD)
SPAM:: -.. ::n vdnn , w v r ' pM'fnn>!^•M'm;:(O W+
CLOTHES DRYER
r :� .r„^.xsecc.
a RANGE :>...:>.. .,,:.., :_ ....: ..>.
GAS LOG
>MISCELLANEOU5_(NOTCOVERED ELS,I,WHERE
k:.r
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTEl7 GAS APPLIANCE,>400,000.B
USED APPLIANCE <400,000 BTU
USED APPLIANCE>400,000.OTU:
AIR HANDLER <10,000 CFM
AIRHANDLER X10,000 OEM
a
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
x60.00
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
x10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/0
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
ce4d7P,G.EG
SUBTOTAL
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