1993, 05-10 Permit App: 93003353 ACN '✓I �0 d �t 0° r Iett
MECHANICAL PERMIT APPLICATION FORM
r. Information Worksheet
JOB STREET ADDRESS: K). , 1806 Felts
CITY/STATE/ZIP: Spnkane Wa 99206
OWNER: Glernie Moore
MAILING ADDRESS: same
PARCEL NUMBER:
PHONE NUMBER'
#7080
5-7-93
927-47R1
J -
II (Street)
511A -
CONTRACTOR: IOCI
MAILING ADDRESS: bi 2 -CL
I N3IA-AbA
(Street)
(City/State) (Zip)
LICENSE NUMBER: aro em I 2 l0 CSF
PHONE NUMBER:
o �,4Af&
(City/State)
LiA 6-P20-1
(ZIP)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GIS. PIPING;{ALir7j<"
BOILER/REFRIG 1-100M BTU
=SOLE# (4FFIIG 1"1�SU' ,611.1
BOILER/REFRIG 501-1,000M BTU
ljOICER REFFUG4 O001q;75pj()T ='
BOILER/REFRIG +1,750M BTU
„Hi AT_P,llMPB tRC;pi ,pini at
HEAT PUMP & AIR CONDITIONER 3-15 TONS
4-4 117` f211Mp ritilnONp1 ' ONIIEWS 1'L "
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HE .A10 )MR.4& 644P.N01TOtEI�: 50T.
VENTILATING FANS
COMV ATNF COmq.1„ 5
G.
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
Ivi1SG L Al g.5KO (r .O'I GOV EtEr Et 0W11EA
UNLISTED GAS APPLIANCE <400,000 BTU
»ULINSTED,GAS` PPtrf6NCE:$L00;606.0.TU
USED APPLIANCE <400,000 BTU
USED"APPOANCE'A6. 000:
AIR HANDLER <10,000 CFM
AIR`k ANDLFR>»OObb4'...'
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
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 =
x12.00 =
x20.00 =
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 =
1
12.00
SUBTOTAL
$ 12.00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
37.00
_ $
Spokane County Division of Buildings