1993, 06-04 Permit App: 93004314 Range, Piping1'
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: - $ / 7 ((')X
CITY/STATEfZIP i'Y). (JA q9o(c PARCEL NUMBER:
OWNER: /7) /Thrrul PHONE NUMBER: 9::721/ -26 N
MAILING ADDRESS::'`
CONTRACTOR: IOQ(l O
(Street)
q-CDICEI
(City/State) (Zip)
LICENSE NUMBER: r )(1(-O On HA17(18
PHONE NUMBER: f'13L/ -CO75—
MAILING ADDRESS: C _��� --1 I 99d/
(Street) (City/State)
MECHANICAL WORK
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT <100,000 pits (INCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLE"T)'
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 901 -BOOM 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
HEAT PUMP *AIR CONDITIONER 15-30TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER 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
U LUNSTED GAS APPLIANCE >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 7, ,z„
(Zip)
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 =
/ 0)
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 =
/®, e
x1,0:00 =
x 50.1)0 =
x100.00=
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ A JO
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ -91,a8
Spokane County Division of Buildings
west Y Iow on/dew/ay Avenue Spokane, WA 99260 (509) 456-3675