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1993, 01-12 Permit App: 93000139 Mechanical Fixtures
MECHANICAL PERMIT APPLICATION FORM �Inforntition Worksheet JOB STREET ADDRESS: / JLI ¶ 5 CUY Ill= /O// GLC/ PARCEL NUMBER: 0042- PHONE NUMBER: con, e (Street) L 1�tb ?09a�i (Street) CITY/STATE/ZIP: OWNER: MAILING ADDRESS: CONTRACTOR: A MAILING ADDRESS: q 3--13q 9zy-92? (City/State) LICENSE NUMBER: PHONE NUMBER: _Ceg7 Lag (City/State) (Zip) aM-nv CS ioolt9 9722 r MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) W000STOVEIINSEERT.>'; GAS WATER HEATER GAS;;EQCJIPMEN7`: 1;Q .000:SW (INCLUDES: GAS EQUIPMENT+100,000 BTU DUCTWORK) GAS:.P PING (SA;:Ot3`t1;0, BOILER/REFRIG 1-100M BTU SOILER/RE G1Q14500M 0'1 BOILER/REFRIG 501-1,000M BTU D:OILERIREFRIG 1 0001 1 ?50M';0Th . BOILER/REFRIG +1,750M BTU HEAT:P.UMY &„AtF3 CONDITIONSp 0-3 TON; HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT`P0MM AIR`CONDIT!ONEf'is`=3b'TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS :HF_ATpUMP8[ JRCONDITIONER`+50:TON. VENTILATING FANS EVAPOF AT(VE:OOOLERS.::' s''+ ;i:iz;":::- TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG MiSct iAblE00SA(N4r GovE> ED ELSE/HEft UNLISTED GAS APPLIANCE <400,000 BTU ULiNSTED'G11S 11PpL(AN4GEyg00 tlg0B11 USED APPLIANCE <400,000 BTU USED. APPUTANGE X400-;000'DT:t'I AIR HANDLER <10,000 CFM AO' FIANDLgrto,000::crivi 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 = x12.00 = x 20.00 = x25.00 = x 35.00 = x 60.00 = x 10.00 = x10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = I (a, - 7 - x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ /q, - PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 29. Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675