1994, 05-02 Permit App: 94003776 Mechanical FixturesJOB STREET ADDRESS:
CITWSTATE/ZIP:
OWNER: ./3---r-e-,+
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
-14- T77(3,
31()(e
PARCEL NUMBER:
PHONE NUMBER: e/_.
MAILING ADDRESS:/
(City/State) (Zip)
LICENSE NUMBER: IV 012 co HA o76 A I
PHONE NUMBER:
(Street)
CONTRACTOR: IV r' -r--',
MAILING ADDRESS:
.4 '
(Street) City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
wc)ot)STOvettN".•..-."...
GAS WATER HEATER
GAS EQUIPMENT 100000 STU (INCLUDES
„ .......
GAS EQUIPMENT +100,000 BTU DUCTWORK)
(140p0.040i(08',01;q4: •)•
BOILER/REFRIG 1-100M BTU
BQUR/REFF1101P14400.W.
BOILER/REFRIG 501-1,000M BTU
BOILERIREFRIG 1.000.1-1 ,750M OTU
BOILER/REFRIG +1,750M BTU
HEATri*.pzAAIR:!OORpiilooeFt:04Torls::
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
:)•7mArevmp.:kAlri:0NotiloNER*4$07QNsigri
VENTILATING FANS
EVAPORATIVECOOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MSCELLANEOUS (NOT COVERED ELEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED.APPLIANCE400;000'BTU.,i.•••••,,
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
x10.00 =
x 25.00 =
Y
xio.00 .
) 0 go
Y
x 12.00 az
x 15.00 ox
x1.00
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 =
x10.00 =
x10.00 =
x 50.00 =
x10.00 =
x10.00 =
x 10.00 =
•
x10.00 =
x 1.0.00 =
x 50:60 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ „ly.00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
SIGNATURE 2-(2
Spokane County Division of Buildings
West 131 "way Avenue Spokane. WA 9A2An Igngl AticA_qA7R