1991, 09-13 Permit App: 91005763 Stove, Pipingf
MECHANICAL PERMIT #PPLICATION FORM
Information Worksheet
JOB STREET
CITY/STATE0P:-&-nyA�-,c.- 2922X,_ PARCEL NUMBER:
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OWNER:c-xj-t.LL� PHONE NUMBER: T ciy?I -or..
MAILING ADDRESS: E IlyZl fi, VLuI«
(Street) (City/State) (Zip)
CONTRACTOR: F. LICENSE NUMBER:
MAILING ADDR
PHONE NUM
(Street) I- (City/State) (zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
:GAS �QU PMfi=1��'�<tf?O,t►�'.�I�l�t���.... .:_.:.:..::�v-:
GAS EQUIPMENT+100,000 BTU DUCTWORK)
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BOILER/REFRIG 1-100M BTU
r::ry.:•..•.,.:cr.,•.:r-r-...,yv;.,.:-::f.:;:.:::.y.W.-..n,.,.::;�c.F`:a'-l.Ginxa,>:•:3rt
nvy.-.:,.K,'v:.:i::-'•.i:A:V;:>i{vi .:.v.:..i: ..._:.._: ..x.h:.x4�G:i�yi Y•$<ifQf _....v... vv:}-firtvsf{,�.3iv.
BOILER/REFRIG 501-1,000M BTU
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s.:,az ,c,-•:,:.,..•••-:.,,Js,�s•..:N.:,.•'i`on::,,,,.... .dhw..,�.:�.yy:�;C�,n..,,-.,:a:,rc2.-Y.-y.,::>:.,•:x::::::.:.:s;<•'•� ...
BOILER/REFRIG +1,750M BTU
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HEAT PUMP & AIR CONDITIONER 3-15 TONS
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HEAT PUMP & AIR CONDITIONER 30-50 TONS
_.:.PU,�+lPAl�t
VENTILATING FANS
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i::.r: v::vi._.iw::::v: n:: iiiy'.;:.i'•: - :syt
rlTv .
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
YP::.
i_._..Y:i•:i}i:UX•iv }ii}:rr::::•:�:•+:yrr- iiiF.•'e.
CLOT_ HES DRYER
G ::
GAS:`...__.............._.....-..._.....-...............-...........-.....................:..................
M <;,
OG
:.:::.::::::::::::.:::::::::::............................................ ....
iSC f.LANEOCIS {NOT G01..... ....
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE>400,000 BTU
........................................ _ ........ :
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
R HANDLER.>10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
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 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00
x 60.00 =
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 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
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