1992, 12-23 Permit App: 92011144 Mechanical FixturesJOB STREET ADDRESS:
CITY/STATE/Z1
OWNER:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
Lt)'7 i r)6 PARCEL NUMBER:
PHONE NUMBER: qY /OW
MAILING ADDRESS:
/ (Street)
CONTRACTOR: D/2 'C0 /C14 < t�
11
MAILING ADDRESS: E. 5/03 3 l f`LP/1i(Street)
DESCRIPTION
(City/State) (Zip)
LICENSE NUMBER: Z4//1/702z:
PHONE NUMBER:% t3:39/-- L/97,S-
SplJ. VZ ?,
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVEIINSERT
GAS WATER HEATER
GAS EQUIPMENT <1;00,000 ETU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIF�4NG (EA.OU7t^ET) - .;
BOILER/REFRIG 1-100M BTU
13OILER/REFRIG 101:S00M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001...1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0 3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HAAT PUMP AIR CONDITION R 15 30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE: COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE; II HOOD
CLOTHES DRYER
RANGE.;
GAS LOG
MISCELLANEOUS (NOT COVERED; ELSEWHERE :
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS,;APPI IANCE;>400 000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR:HANDLER >10,000 CFM;
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
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 1,0.00 =
x 50.b0 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
x (f7
/07 Y
N
09s ()
L
$ d Gf 0
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
�C/
= $