1991, 12-26 Permit App: 91008709 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: ?ut 2 (9 (S
• 87769
CITY/STATE/ZIP: S0._ ((/G{` ¶ (2I a PARCEL NUMBER: U! ]tf/3 . 0220
OWNER: (U i /(vt -P Y I 4 .I PHONE NUMBER: 9Z. 6 - so -2
MAILING ADDRESS: A a lbis- cult -1r Sir_ coo._ raiz_
(Street) Sp
(City/State) (Zip)
CONTRACTOR: Al o.+1^0, ( C IA ;on, Lev LICENSE NUMBER: A2 �y
.` r 0 C S /#,' X 7
p / PHONE NUMBER: 122,-ZD(0(i
MAILING ADDRESS: £ 7B'/6 /St-Oulu/a,,S�ott G4J6v RQi,(Z
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSER7
GAS WATER HEATER
GAS -geuipmENT oo,000.,:ptufluctuoES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET),, ':.,
BOILER/REFRIG 1-100M BTU
:BOILER/REFRIG 101-SOOM>BTU
BOILER/REFRIG 501-1,000M BTU
BOILERIREFRIG7,7)001-iy5oMfPT».:.> ><
BOILER/REFRIG +1,750M BTU
::HEAT PJ)MP& AI[RCONDIUIONEf3 3T£
HEAT PUMP,; & AIR CONDITIONER
HEA 'cUMP S 12tOND1T(OwERn-IONST r
HEAT PUMP & AIR CONDITIONER 30=50 TONS
HEAT PUMP:$' AIRCONOrTIONERt5DTONS
VENTILATING FANS
rEVAPVRiv:eots
HOnr;u m
TYPE I OD (PER 12' OR 12' PIN. OFHOOD)
IYP,�g HOt)E3' <;;
CLOTHES DRYER
GAS LOG
MISC _ `"EL ANEOUS (NOT COVERED ELSEWHERE" r
UNLISTED GAS APPUANCE <400,000 BTU
UU ED:;IGASAPPL1ANCEsgOb;O
USED iSTAPPUANCE <400,000 BTU
USED: APPLIANCE 400;000:.
AIR HANDLER <10,000 CFM
AIR HANDLER,S'10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUREeU t-4
(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 =
2.0(9
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x12.00 =
x20.00=
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 =
x50.00 =
x100.00 =
x 12.00 =
x 15.00 =
7. O. d0
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 97,00
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675