1992, 06-29 Permit App: 92004805 Mechanical FixturesMECHANICAL PERMITAPPUCAT1ON FORM
Information Worksheet
JOB STREET ADDRESS: 1/ 0 A) , ) Cf' )
CITY/STATE/ZIP:. i 9
f�E�r�RNE �� �/01 PARCEL NUMBER:
OWNER: nt h-�/ % N67 PHONE NUMBER:
MAILING ADDRESS: SA fr , Z -
(Street) (City/State) (Zip)
CONTRACTOR: MSM INC (MARTIN SHEET METAL INCLICENSE NUMBER:MA RT IS M170KW /C600 470 101
PHONE NUMBER: 924-8088
MAILING ADDRESSBLDG 103 SPOKANE INDUSTRIAL PARK SPOKANE, WA 99216-1609
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWOR
WOODSTOVE/INSERT
GAS WATER HEATER
:GAS EQUIPMENT`<10i
GAS EQUIPMENT +10(
:GAS p IPING(FADUTL
BOILER/REFRIG 1-10(
1.0:0140g..00.1:01=:
BOILER/REFRIG 501
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP& AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIF.
HEA ► PUMP & AIR CONL.. ,;)NER 30-50 TONS
HEATPli:MQ� AIR CONDITIONER +50 TONS .>:
VENTILATING FANS
TYPE I HOOD (PER -
CLOTHES DRYER.
RA
GAS LOG
MISCELLANEOUS (NOT COVERED'ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE X400,000 BTU
USED APPLIANCE <400,000 BTU
-USED' . I?P:.tANCE>f40.0�004 BTU
j AIR HANDLER <10,000 CFM
i 'AIR HANDLER` W,61i0'CFM
X 35.0C.,
x 60.00 =
x 12.00 =
x 20.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
. r♦
NOTE: MINIMUM PERMIT FEE IS $35.00
• SIGNATURE il
Gi2((ktrA,
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
+ $ 25.00
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
K (SEPARATE SYSTEMS)
::... :.„:, ;
x 10.00 =
x 25.00 =
x10.00=
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x20.00 =
x 2-: 00 -
J,000BTU(l0CLUDESz�:;:;;„;;.?��'=:
),000 BTU DUCTWORK)
/
/O,Dc
nv.
/ o
)M BTU
00MBTU :> h.
1.000M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP& AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIF.
HEA ► PUMP & AIR CONL.. ,;)NER 30-50 TONS
HEATPli:MQ� AIR CONDITIONER +50 TONS .>:
VENTILATING FANS
TYPE I HOOD (PER -
CLOTHES DRYER.
RA
GAS LOG
MISCELLANEOUS (NOT COVERED'ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE X400,000 BTU
USED APPLIANCE <400,000 BTU
-USED' . I?P:.tANCE>f40.0�004 BTU
j AIR HANDLER <10,000 CFM
i 'AIR HANDLER` W,61i0'CFM
X 35.0C.,
x 60.00 =
x 12.00 =
x 20.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
. r♦
NOTE: MINIMUM PERMIT FEE IS $35.00
• SIGNATURE il
Gi2((ktrA,
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
+ $ 25.00
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675