1992, 10-30 Permit App: 92009586 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
4 Information Worksheet
O,
JOB STREET ADDRESS: 42- (79 SteArc_ i; Sn r� H
I � ����
CITY/STATE/ZIP:W .16
o o.G 99z(2._s 4 . 99Z(PARCEL NUMBER:
OWNER: Je 44c 4 -freer-- PHONE NUMBER: y? -2 88
MAILING ADDRESS: -=-
(Street) (City/State)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Zip)
(Zip)
(Street) (City/State)
MECHANICAL WORK
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
:WQQDSTOVEIINSER
GAS WATER HEATER
AS:>nQUlpt fSNT :t?9...... U {iN......7ES:o
• GAS EQUIPMENT+100,000 BTU DUCTWORK)
4.W.0.pINGA1 AtQ0r..1-
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
aQiLER/RSF(-11Gs1ao001::1:.7:50M i#
BOILER/REFRIG +1,750M BTU
HEAT;PUMP::&:AIFI CONpITIONER:sO_3:TANS:
HEAT PUMP & AIR CONDITIONER 3-15 TONS
,HEATPUMP;`&.Alk':COND.ITIONE :1:SYS0=TO, S
HEAT PUMP & AIR CONDITIONER 30-50 TONS
H A7..f?UNtP b<14§111014414.0:::
VENTILATING FANS
EVApO, ktN,=„CgO.g.
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
.TYPEILHO :15:1:...:
CLOTHES DRYER
GAS LOG
MLSCELLANEQUS (NQTCOVEIRED'ELSEWHER
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED?GASIA?pt tANC 490;0010'1):
USED APPLIANCE <400,000 BTU
USED.' APPLIANCE40. 000„ BTU:;':"
AIR HANDLER <10,000 CFM
AIR HANDLER>1O 00O CFM"'::
NOTE: MINIMUM PERMIT FEE IS $35.00
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 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x10.00 =
/
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675