1992, 09-04 Permit App: 92007267 Mechanical FixturesCujp7 "OCC -A^ \CA9MECHANICAL PERMIT APPLICATION FORM
I,- S I g - 262Intoarnatio Worksheet
JOB STREET ADDRESS: 4622 N
CITY/STATE/ZIP: Spokane, WA 99216 PARCEL NUMBER:
alt -1 D. -7
OWNER: Gail Brown PHONE NUMBER: 928-2304
MAILING ADDRESS:
CONTRACTOR:
MAILING ADDRESS:
(Street)
3655 Goyt. Way
(Street)
(City/State) SUNLOI107J6 (Zip)
LICENSE NUMBER: SUNLOI101JB
PHONE NUMBER: 455-4147
Coeur d'Alene, ID83814
(City/State) (ZiP)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER
DESCRIPTION OF UNITS
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER 1
GAS EQ.01PM<100,000 8113 (INCWDES . 1
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS°P1pWG
BOILER/REFRIG�1-100M 8111
EI -0 i O'1="600M 6TC1F
BOILER/REFRIG 501-1,000M BTU
BOI EFFI G <1 0001= tr750M:BTU `i
BOILER/REFRIG.1,750M BTU
HEAT M rdp .0400001:0370NS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
Jt.E t ?CONritfa R 15 tot S
HEAT PUMP & AIR CONDMONER 30-50 TONS
0421 'I P M COf;1DIi01:0 450: ONVS',:
VENTILATING FANS
EVAP,�ORA7I 709:0LERS . .
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPEIT`-m ,.
CLOTHES DRYER
GAS LOG
MISCELLANEOUS MOT COWERED ELSEWHERE
UNLISTED GAS APPLIANCE <a00A00 BTU
ULINSTED GAS APPUADOCIE >CSC STU
USED APPLIANCE <400.000 BTU
USED APPUANCE »00A00 STU
NUR MANGLER <10.000 CFM
AIR HANDLER >10.000 CFL
X EACH
UNIT
= AMOUNT
2
NOTE: MINIMUM PERMIT FEE 15 $35.00
SIGNATURE
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.03 =
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 =
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 =
x50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
1
10 0-0
12.00
2.00
SUBTOTAL
$ 24.00
PLUS: PROCESSING FEE
$ 25.00
EQUALS' TOTAL PERMIT
FEE DUE
=$ 49.00
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA. 99260 (509) 456-3675