1992, 09-17 Permit App: 92007773 Mechanical Fixtures.450‘k c `( MECHANICAL F�RMI7APPLICATION FORM 9._1'7 3
•eQ't
otic L,a lb. i Inter:nation Worksheet
JOB STREET ADDRESS: 4717 N.- Larch (030
CITY/STATE!IP: Spokane, WA 99216 PARCEL NUMBER:
OWNER:Jerry Girard PHONE NUMBER: 922 7699
MAILING ADDRESS:
(Street) (City/State) SUNLOI107J6 (Zip)
CONTRACTORSnland Heating & Cooling LICENSENUMBER:SITNT,fT101J.b
PHONE NUMBER: 455-4147
MAILING ADDRESS: 3655 Govt. Way Coeur d'Alene In R3R1a
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVERNSERT
GAS WATER HEATER
GAS EQUIPMENTz100,000 BTU (INCLUDES:
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GASAPING'{EAOUTLETj:;..
.BOILER/REFRIG 1-100M:BTU
NUMBER
OF UNITS
X EACH
UNIT = AMOUNT
BOILER/REFRIG 501-1,000M BTU
.BOILEWREFRIG 1,0001 1:;75OM BTU,<<;;?''::. . .
BOILER/REFRIG +1,750M BTU
HEAT PQ 1Ff-GONgt]tONEA 0-3:;JONS_`_:: 1;
HEAT PUMP & AIR CONDITIONER 3-15 TONS
H,FIATAI1_BIW&A1R`CONDITIONER SA(ftONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
H4MO1 OM ONDmowER+50 TONS".
VENTILATING FANS
.EVAPO,MTINOQOLERS . . .
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
ci OW. ;,-.
-A :,
TYP
CLOTHES DRYER
RANGE r - ... .
GAS LOG
MISCELLANEOUS (MOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <A00,00D BTU
UUI STED GAS APPUILICE >4C0m0 STU
USED APPUAt4E a$313.000 STU
USED APPLIANCE aelt0001371J
AIR HANDLER c10.000 CFR
AIR HANDLER>10.000 CFM
1
1
2
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.03 =
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 =
x50.00e
x100.00 =
x50.00=
x100.00 =
x 12.00 =
x 15.00 =
10.00
12.00
2.00
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
$ 24.00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=s -49.00
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA. 99260 (509) 456-3675