1992, 04-09 Permit App: 92002337 Mechanical FixturesJOB STREET ADDRESS:
CITY;STATEJZIP:
MAILING ADDRESS:
q,ACTOR
ADDRI=;;S
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
- l O PI 7 77 ex,c w
/�
IL/l_1_
PARCEL NUMBER:
PHONE NUMBER:
SMITHRIMINO
E. 102 NOR,' -k.
SPGKANE;1 A 99247
(509)328-4431
WAYNESH258NJ
(tree1)
(CitylState)
LICENSE NUMBER:
PHONE NUMBER:
(Cit /State)
MECHANICAL WORKSHEET/FEE SCHEDULE
_DE
,-SEPARATE 'S 1 EMS'
WQOD; Tj.,_,,I.: n.
GAS WATER
GAS EQUIPME: C'C; 00o BTU (i^:CLt f s
CAS EQ4,•ir'•:,,.t2, i - -10C,000 BTU CLIC° r WORr4.
N ^ L
.tRJR;i
R%R� r=BIG 101-50c':' PT?I
• . PBS.
T r, MP
V.•p •i� I' ' '
CLOTHE
RANGE
GAS
MriLSCf . m (NOT ( `EKED ELSEWHERE
Vit., , c.! <400,000 bTt)
AS APPLIANCE CE >400,000 BTU
i APPLIANCE <400,000 BTU
APPLIANCE >400,000 BTU
Ar` -:17) .E'R <10,000 CFM
HANDLER >10,000 CFM
NOTE: MINIMUS.
EE IS $35.00
SIGNATURE_ , 4`', ( >-jt,f
(Zip)
NUMBER X EACH
OF UNITS 1 UNIT
x 10.00 =
x25.00 =
-
I
x 10.00 =
x 12.00 =
15.00 -
x 1.00
x 12.00
x 20.00
x 25.00
s C> .00
x ,2.O0
x 20.000 .._
25.0,_
35.00
x60.0
x 10.00
x100
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
= AMOUNT
() tic/
r --
i
F
SUBTOTAL k $
PLUS: PROCESSING FEE L $ 25.00
EQUALS: TOTAL PERMIT
FEF DUE = $ 3 �'
Spokane County Divisi.:. ci Buildings
'Viact 1
i. n r...on.