1993, 06-18 Permit App: 93004781 AC46332-, ) -/ C} Cj► Tc-.& frU jL 1 P 1
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet L --1-i0 f 1 / 0
JOB STREET ADDRESS:_
CITY/STATEIZP:
OWNER: /if
MAILING ADD ESS:
CONTRACTOR: /L-A(Y-e0
PARCEL NUMBER: M 3 3).-13) 0
PHONE NUMBER: 9W- l&' 37
(Street)
MAILING ADDRESS: 610 i /4--
(Street)
4_(Street)
DESCRIPTION
(City/State) (ZIP)
UCENSE NUMBER: kYIren (OA/ ?Of C
PHONE NBER: 5w -y775
q/q7/;
MECHANICAL WOR
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOMINS RT
GAS WATER HEATER
GAS EQUIPMENT l ,000 BTU (INCLUDES;
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILERIREFt 0101 * 500M STU
BOILER/REFRIG 501-1,000M BTU
BO..I.LERIREFR1G 1.0001.1,750M !B'
..................
BOILER/REFRIG +1,750M BTU
Hpq,:ppm?..4.AIRippNplyipmg11
HEAT PUMP & AIR CONDITIONER
HEAT PUMP &;AIR COONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER;
VENTILATING FANS
EVAPORATIVE ,COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II H000 .
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS•(NOT COVERED ELSEWHEF
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPI IANCE ►400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000 CFM
0-3 TONS
9-15 TONS
15-+30TONS
30-50 TONS
+50 TONS;
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(City/State)
(ZIP)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00=
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x50.00=
x 10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x 1,0.00 =
/2, a(
x50.00 =
x100.00 =
x50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ /.?, a)
+ $ 25.00
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
37 CO
_ $
Spokane County Division of Buildings
Wkst Avc9nlis Rnnkant WA 9 2A) M.91456-3675