1991, 03-28 Permit App: 91001432 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 5 3 / Z L�= • /?
PARCEL NUMBER:
PHONE NUMBER:
CITY/STATE/ZIP: /Za u -e
OWNER: (.3170k Met -4^ S Gi le /-
MAILING
MAILING ADDRESS: S 2- /9,t4' ,4
`25: 3 �y
92 y -
(Stree) (City/State) (Zip)
CONTRACTOR: �'/ � S +�/f r 9,- LICENSE NUMBER: /7//1'/9S5- /p -C2// .
aI %� PHONE NUMBER: 92A - 3 7e)'/
MAILING ADDRESS: 51/ 5gj;liA-e % ,20 C'
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTbVE/INS
GAS WATER HEATER
GAS EQUIPMENT <100,t 0 TU (INCtl�D S
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING(EA OUTLET);
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101 M;R
.......:.....................:
BOILER/REFRIG 501-1,000M BTU
BOILER/RI=FRIG 1, 001 1,750M
BOILER/REFRIG +1,750M BTU
::HEAT PUMP; filPORDITIOI4ER
HEAT PUMP & AIR CONDITIONER 3-15 TONS
;HEA, ?1JMP AIR CONDITIONER.1 -30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
EAT PUMP $� AIR CONDITIONER +50:TONS
VENTILATING FANS
EVAPORATIVE COOLERS' ;:; :;:;;::
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
:MISCELLANEOUS (NOT COVERED ELSEWHER
UNLISTED GAS APPLIANCE <400,000 BTU
ULIN$TEMOASAPPLIANCE>4p0,ti0
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
AIR ., ,
..:: LEl��ytS�4QQCPM_.
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x 10.00 =
x12.00 =
/- , o-°
x 15.00 =
x 1.00 =
/r, 9
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 =
x10.00 =
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 =
x 15.00 =
SUBTOTAL
$ /3, do
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