1992, 08-07 Permit App: 92005904 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
InformatiLIn Worksheet
JOB STREET ADDRESS:.. Z ("-
CITY/STATE/ZIP:� `xJC'�,Cl iCc L.�_'�� PARCEL NUMBER:
OWNER:_ 1)
to%.I<_ cX� �'"Ct f �; ["� PHONE NUMBER:
MAILING ADDRESS:
trent) (City/State) (Zip)
CONTRACTOR: i' y'C>Gltl P L:S LICENSE NUMBER: lr C ,4
AILING ADDRESS:
�jt a j c CCCY f
tea F _ 7-30 -92
X ci�
(Street)
PHONE NUMBER:_
tyet1i -.
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
.......................................................................................................................
0. . ..x....8! ..S ........ .
0
. .. ...... . .......
:::::.... .... ..
...................................
GAS WATER ..
........
GASQUIPNII=NT.100�t�p!TU>(ICLUII=S:..
......:.......................:.:................::.............:............:......:............. .......................
GAS EQUIPMENT +100,000 BTU DUCTWORK)
.......................................................................................................................
.......................................................................................................................
GAS PIPING.. fA OUTL.
..:...........:.::.::.:.....:.......::........................:..::
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
.EMAP tER' . . <`<>>>>>>><<'>><><>:<. <.
_..........0....A'l"..........CO ...... ra.........................................................................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD):::::::...........
'Y'Y...8..11..I�OOU...................... .
CLOTHES DRYER:.:::.::................................................................................
GAS LOG
M1SOL.LANCUS (N07 ��JVE1lD ELSEWHEfiE
..........
UNLISTED GAS APPLIANCE <400,000 BTU
..........................................................................................................................................
...........................................................................................................................................
ULINSTED+GASAP10 'N�E�d00,a7�C�0BTU '"
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
IR A�vr�LF: 1o,0..00+��.:.:::.::.::.:::.:..:::.:::.:.::>.:::.::.:::::.
.......................................................................................
NOTE: MINIMUM PERMIT FEE IS $35.00
i
SIGNATURE
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 a
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
o
SUBTOTAL
$ C)o
PLUS: PROCESSING FEE
+$ -25:00--
EQUALS: TOTAL PERMIT
FEE DUE
_ $ /- cm
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675