1992, 04-15 Permit App: 92002510 Mechanical FixturesJ `
0IGjJ�ve MECHANICALPENMIT APPLICATION FORM
.oc*C�,-c8. Q0, c\i '1 Information Worksheet
JOB STREET ADDRESS: N4 3Si() G'
CITY/STATE/ZIP. .. [crime U114 7%0212 PARCEL NUMBER:
OWNER: f�L° t71 u D. `l n vl.So h PHONE NUMBER:
MAILING ADDRESS:
.S4/14
(Street)
CONTRACTOR: OIC N 6-
MAILING
,r
MAILING ADDRESS:
(City/State)
LICENSE NUMBER:
PHONE NUMBER:
(Zip)
(Street) (City/State)
MECHANICAL WORK
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
V N
...........
GAS WATER HEATER
:.>::<. ::.,,�.�•.......:• .«c:i ..... a:......ii....:i�a'w':i`i:i'iiFiFrcri:j;: ...................
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HES►:::::€::;:.: MEQ: & AIR :ONT I I+.0 NER 0-3 ONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT P Ji P & AIR>C Ii I I: NER 155 0 TO S
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT:PUMP:: MR C Nt ITI+ NER +50;TC NS>'' »><
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
lul S I LAi E I S (NO'# COVERED ELSEWH
UNLISTED GAS APPLIANCE <400,000 BTU
IrlLINSTED GAS.:AP'LrIAN± E; 00 000.:BTU
.::.......::..::..:....:..:...:..:.:..:...:..:...:......:::.:..:........:::.... ..:::.....
USED *APPLIANCE <400,000 BTU
ai:� w'w:::fww+F:�%:;<i<iii:Si::>a>':'i<i':':':
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(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 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
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 =
to. <se
-a. txfD
LO _ o`e)
SUBTOTAL
$2.oAr
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 47_ co
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675