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1991, 09-17 Permit App: 91005885 Mechanical Fixtures
MECHANICAL PERMIT APPLICATION FORM InfanatioA Worksheet JOB STREET ADDRESS: So- gFilieS/41 3/ 3 L EAl fHA L Y/ CITSTATE/ZIP: SPO , ' 6 W k ?-:321 PARCEL NUMBER: �- S C / -14)6.1\ OWNER: UJCR /J ER I5A-/S'679 PHONE NUMBER: MAILING ADDRESS: S'O• 31 F L E4 TNA (Street) (City/State) (Zip) CONTRACTOR: MARTIN SHEET METAL INC. LICENSE NUMBER: MARTISM170KW PHONE NUMBER: BLDG. 103 SPOKANE INDUSTRIAL PARK SPOKANE, WA 99216 MAILING ADDRESS: DESCRIPTION (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQUIPMENT:<100;000BTU(INCLUDES:::_: GAS EQUIPMENT+100,000 BTU DUCTWORK) GAS PIPING EA.OUTL BOILER/REFRIG 1-100M BTU BOILER/REFRIG:101=500M BTU::::;:.:'::::'. BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1;0001_-1,750M:BTU BOILER/REFRIG +1,750M BTU HEAT -PUMP-& AIR.CONDITIONER:0-3 TONS':: r: HEAT PUMP & AIR CONDITIONER 3-15 TONS ' HEAT.PUMP_&AIR:CONDITIONER 15-30;TONS.`::;'s,.; • 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). • . . . ;'r T` :; CLOTHES DRYER • GAS LOG MISCELLANEOUS(NOTCOVERED,E,LSEWHERE:::1- 7. UNLISTED GAS APPLIANCE <400,000 BTU ;ULINSTEDGAS APPLIANCE_3400 000;BTU USED APPLIANCE <400,000 BTU USED APPLIANGEj>480;000,t3TU°m' AIR HANDLER <10,000 CFM AIR NANDLER:*10;0odCFM==:::.. NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE Lej? Attach Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 RP) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x10.00= x12.00= x 15.00 = x1.00 = 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 = x10.00 = x 10.00 = x50.00 =. . x'10.00=: x'1.0.00'= '.: x10.00 = . x 10.00 = x10.00 = x 50.00 = x100.00 = x50.00 =.. x100.00 = x 12.00 = x'15.00=..= / /o00 /aoo a a©G .. SUBTOTAL $ 990 O PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE �/ =$ /q00