1993, 03-19 Permit App: 93001638 Mechanical FixturesMECHANICAL ?ERMIT APPLICATION FORM 13
Information Worksheet �9U�
JOB STREET ADDRESS: 6. f /S03 n' /l C L.
CITY/STATE/ZIP: ade_[J% 9$2Q/ PARCEL NUMBER:________
OWNER: jeiQR�//Skin-6R PHONE NUMBER: Tay -3(o R
MAILING ADDRESS:,_ _ �.
(Street) (CityiState) (Zip)
CONTRACTOR: JF.4 / _j am e LICENSE NUMBER:_WeAR'I_�,_.*6- MSJ 3
PHONE NUMBER:B
MAILING ADDRESS -9,335 £po 9-,1Je, kf}. f9a/
(Street) (Cay/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT H
GAS WATER HEATER
GAS EQUIPMENT'<100,000'.BTU (INCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING'(EA'OUTLET),'
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG :101`-500M.BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG,.1 0001,-1,750M:BTU -
BOILER/REFRIG +1,750M BTU
HEAT,PUMP.t&'AIR CONDITIONER:0-3 TONS' --
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT, PUMP & AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
:HEAT PUMP. & AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS- ..
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
GAS LOG
MISCELLANEOUS.`(NOT,COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED 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
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUR��
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =-
x
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
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 56.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
1
\:-. - CSO
\
\ -(Yi
SUBTOTAL
$ \_
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
. FEE DUE
f�7�
=S'3�,W
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675