1993, 04-20 Permit App: 93002720 Mechanical Fixturesc\5(8Q e Igr3
EI(Li CK/W3 g MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
r,
JOB STREET ADDRESS: 1/3 ` .t) N4 f et 4., xis o,.✓
93-z72O
CITY/STATE/ZIP: SA.I %boa/ aJjQ PARCEL NUMBER.
OWNER: ehIAtud Co,JL,px1 S6 PHONE NUMBER:
MAILING ADDRESS: // 3 - iu /4,TC' L I
(Street)
CONTRACTOR: e1,.-. 4 /,ke4h.u5 )i- C.
MAILINGADDRESS: C- 7l1.3-owP.'S /Z
(Street)
u5
0
DESCRIPTION
3I M51-1AS1-31N'&
(City/State) (Zip)
LICENSE NUMBER: 4-0nsAA6 (3/ a>4
PHONE NUMBER: </ LF -S- 916.0`)
CLt fit/COOA . trice 00
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/IN,S''':'::;..?.:':
GAS WATER HEATER
GAS g4Q)pMEN IEC6I001M IN 1-00 „
GAS EQUIPMENT +100,000 BTU DUCTWORK)
S PIPING ( A O itlIT 3 M<k [
BOILER/REFRIG 1-100M BTU
>0p1111,1W I C f,01 500kt `
BOILER/REFRIG 501-1,000M BTU
901.1:EH/I PRFG1:;a.Ofis tti6 t
BOILER/REFRIG +1,750M BTU
:44, t` PltMt7� FM G;4N Sura nT41
HEAT PUMP & AIR CONDITIONER 3-15 TONS
lihvvvry uvW Ww
HEAT PUMP & AIR CONDITIONER 30-50 TONS
toEA i p;U mmovototowimitt:
VENTILATING FANS
PAP OCKM:1010: Inc e
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
RlSCEkni;I MS7GS (NR GC3 ERECiteSEW, iE
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
<MSEQ AP..NANCiraa0m00`BTUrs
AIR HANDLER <10,000 CFM
AiANOWEt?70(00.4:C
NOTE:. MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
x 25.00 =
x10.00 =
x12.00 =
x 15.00 =
x1.00 =
x 12.00 =
x20.00 =
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 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x15.00 =
- -
AD,do
/a,00
2 ---
,
SUBTOTAL
$ A -
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
4) ' J
= $
Spokane County Division of Buildings