1992, 11-30 Permit App: 92010403 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
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JOB STREET ADDRESS:.5.305- L - L,M,f>
CITY/STATE/ZIP• , 67! (t)%) /(Y/' PARCEL NUMBER
OWNER:/fJ3C4 (1 PHONE NUMBER:
MAILING ADDRESS:
1
(Street) ,
CONTRACTOR: ;%Aeop,
MAILING ADDRESS: --)/ 3 74c
(Street)
DESCRIPTION
(City/State) (ZIP)
LICENSE NUMBER: /VICZ%J/6/
PHONaNUMBER: ..53/1.--.4/42_5-
. 4/42 5-
Z) /ye
MECHANICAL WORK
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVEIINSERT:
GAS WATER HEATER
GAS' QUIPMENT <1 QQ,000
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTk
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG101--500M `BTU
BOILER/REFRIG 501-1,000M BTU
BOILER1FEFRIG 1,0001 1,750M STU
BOILER/REFRIG +1,750M BTU
........... ... .
HEAT PUMP & AIR .CONDITIONER0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15 30. TONS;;
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP &AIR CONDITION R'+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 CO fEREQ' ELSEWHERI
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED 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
(city/State) (Zip)
I NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
v
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 =
A..7-.4)
x1.0.00 =
x50*. 0 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ A). a:
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
1O 7 6
= $
SIGNATUREe-- -r `
Spokane County Division of Buildings
1Aloct 1Qr1Q Prnariwav Avoniip Snnkane_ WA 99260 (5091456-3675