1992, 10-15 Permit App: 92008955 Mechanical PermitMECHANICAL PERMIT APPLICATION FORM C9~
Information Worksheet
JOB STREET ADDRESS: I' i ?t' / c &i Oe►(,H gO AVE �- 02
CITY/STATE/ZIP: .-itel2euvio,, Alii . 9 9 D / a r PARCEL NUMBER: 1--i 5ic(6-
OWNER: gai
i� PHONE NUMBER: c% v2 �✓ 6J
-07
p',
MAILING ADDRESS: J % a V ��" '����-��y ,li ii etAt., .9) l a -
(Street) (City/State) (Zip)
CONTRACTOR: 01-1771-e LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
DESCRIPTION
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
InT
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
u KA:V
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
•
AIR HANDLER <10,000 CFM
H
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x1.00 =
x12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x60.00 =
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
j
j
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