1991, 10-23 Permit App: 91007100 Furnace, PipingPLUMBING, PERMIT APPLICATION FORM
Informatidn Worksheet
JOB STREET ADDRESS: �Z"?.7'A -( E ter/L�-
CITY/STATE/ZIP: 5 / '1�-Ac W 99c,..5 -Ir -2 -PARCEL NUMBER: 0
OWNER: CDtA \ Lt°r2S�APHONE NUMBER:
MAILING ADDRESS: jn-VV`e—
pCr(fSStreet) f/e_ (City/State) (Zip )
CONTRACTOR: --, tTC.V�LICENSE NUMBER: N _PO RA --(14 I c
Op
10NE NUMBER: 7 37,/
MAILING ADDRESS: CO `ipMICH[OE t�,('
V
(Street) . (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
TOILETS
SINKS :.
SHOWERS
BATH TUBSi`:
KITCHEN SINKS
DISH WASHERS;.::,: --
GARBAGE DISPOSAL
CLOTHES: WASHER°:` - -
UTILITY SINKS
ELECTRIC. WATER: HEATERS
FLOOR DRAINS
F..LOOR SI:N.KS
BAR SINKS
;ROOF DRAINS `;;:.<' :€ s:°::'::.:.::' ;r
LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE
SEUVAG.EEJECTOR -. _:_
WATER SOFTENER
URINAL
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
MECHANICAL PERMIT APPLICATION FORM
Informatirii Wbntshet;)t
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODS.TOVEfINSERT :..:. .::.:
GAS WATER HEATER
GAS:EQUIPMENT ;et 00,000.6TU`(INCLUDES:_':_-_.
GAS EQUIPMENT+100,000 BTU DUCTWORK)
qAS ,PIPING {EA :OUTLET);;€;_:
BOILER/�REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
!!011 1/AEFR1G 1 000V4 750M:DTU;;` ' Cs:
BOILER/REFRIG +1,750M BTU
HEA T'.PVMP_$AIRCONQITIONER 0.3
HEAT PUMP. & AIR CONDITIONER 3-15 TONS
ItEAMPUMPileARKONDittON ER 1540 TONS €;'° ` "_ > _
HEAT PUMP & AIR CONDITIONER 30-50 TONS
4HEAT PUMP =AIF: tONDITIONEii +50,TONS:' :
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
NQSGEU.ANEOUS (NOTCOVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
UUNSTED;GAS:APPLIANCE>400,00O.BTU:'
USED APPLIANCE <400,000 BTU
USE0'APPL.IANGE:>400 000;BTU.:
AIR HANDLER <10,000 CFM
AIR HANDLER°>10,000;CFM '. -
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
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 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
1 $
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675