1992, 08-20 Permit App: 92006665 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: -3
CITY/STATE/ZIP:At�e 4C/ 0.. PARCEL NUMBER:
OWNER: PHONE NUMBER: CJ.? GXFO
MAILING ADDRESS: ^ Q
(S�tr�eet)� (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER: GAJ 11A-rl�r} C
PHONE NUMBER:
MAILING ADDRESS:2_
(Street) 41 (City/State) - (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
VNO C't7V'. INSI_i <>:'<>'>>>>»<«>>:s>><<:>>
GAS WATER HEATER
GAS EQU.1pf A,ENT �10Q►t)t)CJ B711(INCLUDES'g:1.`:*::
......... ...... ......::..:. _.....
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
.aOILF/ EFFIG 1'' 001 7M B <»`'<:.
:.: :....:::....: �Q.... ..5 :::;;;;::::........
BOILER/REFRIG +1,750M BTU
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00
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 =
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 =
x 50.00 =
X100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
l 0
�2
oL
/
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
qq
=$ tk 1
SIGNATURE � ,�.
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675