1992, 02-13 Permit App: 92000539 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
\(� Information Worksheet
JOB STREET ADDRESS: \ \C 7 l t C O. ‘Q..A
CITY/STATE/ZI,\ °Ra a PARCEL NUMBER:
OWNER:'\Q\ lS\L\&\9 PHONE NUMBER: 131\ --Th. -
MAILING ADDRESS: Q
t \ (Street -(City/State) (Zip)
CONTRACTOR: •P h�P� IS • •.4 \)k ' • LICENSE NUMBER: ��
-\�l�� y\
\ �y PHONE NUMBER: l`� O 1�
MAILING ADDRESS:
a S•
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
. WOODSTOVE/INSER(
GAS WATER HEATER
GAS EQUIPMENT <100,000. BTU,(INCLUDES:
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING:(EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG:101=500MBTU°";;
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001.-i 750M BTU : :-: :.
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR. CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP.&AIR;CONDITIONER15=30:TONS,;.
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP.;&`AIR CONDITIONER::+50 TONS ..
VENTILATING FANS
`EVAPORATIVE;COOLERS.'
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPEII:HOOD°%:::. .. __
CLOTHES DRYER
GAS LOG
MISCELLANEOUS (NOT COVERED, ELSEWHERE.,
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS' APPLIANCE>400,000:BTU.
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUZIPS- \ ` �X CJLt
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
I
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
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 =
x25.00 =
x 35.00 =
x60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =-
x
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =i-
x
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
1a.CO
\, QtJ
SUBTOTAL
$ \3,C(O
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_$ -.Cb