1990, 01-08 Permit App: 90000095 InsertMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 4E. //5/O G�gce
CITY/STATE/ZIP: 5POKA4IE /IJIA / 992k =PARCEL NUMBER:
OWNER: JUJAIN) G. YVaovs
MAILING ADDRESS: E, //.3/G 6e4cr
PHONE NUMBER: 9 Z4-179tp
(Street)
CONTRACTOR: OWAat,
MAILING ADDRESS:
(City/S ate)
LICENSE NUMBER:
PHONE NUMBER:
19Za4
(Zip)
(Street)
(City/State)
(Zip)
MECHANICAL
DESCRIPTION
WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UTNIT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12'
TYPE II HOOD
CLOTHES
RANGE
DRYER
OR 12' PTN. OF HOOD)
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED 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
1
= 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
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
5.00
NOTE: M,NIMUM PEj2MI'Il FEE IS $35.00
SIGNATURE (/JjJh%n� }(0) JALOOA O
SUBTOTAL
25.00
PLUS: PROCESSING FEE
+ $
25.00
EQUALS: TOTAL PERMIT
FEE DUE = $
=V .6U
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675