1992, 07-15 Permit App: 92005307 Mechanical Fixtures2MECHANICAL?E'RP1IT APPLICATION FORM
�-� ((�C�TIG� - a Information Worksheet
JOB STREET ADDRESS: /-2 er)?
1)/2).
CITY/STATE/ZIPSS('- (,)f9 91,72/ PARCEL NUMBER:
OWNER: p.6E P 7 -RJ/ D ( / PHONE NUMBER -7
MAILING ADDRESS:
(City/State) (Zip)
LICENSE NUMBER: it..e.,Wec)///9/ 70/' 2 -
PHONE
PHONE NUMBER: 53 / 6/973
PIE. (_t)fi %%3/ -
(City/State)
- 3o7
obT7
(Street)
CONTRACTOR: /w242G, // 7/t ) G
MAILING ADDRESS: -' • T('07
DESCRIPTION
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
O
TpV ...
GAS WATER HEATER
GAS; EQUIPMENT <100,000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS:<PIPING EA Tt
QUR...
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
.............................
...................
BOILER/REFRIG 1,0001'....1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER ;-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP 5 AIR CONI ITI 3NER 15.30 TONS ,.
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP.& AIR CONDITIONER 450 TONS ...,,;
VENTILATING FANS
EVAPORATIVE COOLERS
....................................................:.....................................................................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
............................................................................................................:..............
CLOTHES DRYER
............................................................................................................................
GASLOG::.. ,...............................................................................
MISCELLANEOUS (NOT COVERED...ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
..........................................................................................................................
ULINSTED :GAS APPLIANCE >400,000
....:...............:..................:..:............:........:....:.............:..:............:::.....:...........
USED APPLIANCE <400,000 BTU
...........................................................................................................................
USED. APPLIANCE >4
AIR HANDLER <10,000 CFM
....................................................................................................................... .
AIR .HANDLER >10,000 ;CFM
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 =
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 =
x50.110 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
N
/C a
N
la2 ,(Z
' ,
/ ex)
/cf), a)
SUBTOTAL
$ $S, db
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ CCC'
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675