1992, 03-06 Permit App: 92001328 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
/ Inforrmat ion Worksheet
JOB STREET ADDRESS: \ )3 1 'n\t4 I VU
CITY/ST TE/ZIP: I. :.i
OWNER 1) t l nn \ ? cJmA,bcon PHONE NUMBERC 1 / 9/2nci.LCn
PARCEL NUMBER: :/2525-5/..3 & Jc
MAILING ADDRESS:
CONTRACTOR.
MAILING ADDRESS:
DESCRIPTION
�i ter_
r (Street)
(Strut)
(City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
i3_ /&3
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT "
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU.;(IINCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS'PIPING EA.OUTL
BOILER/REFRIG 1-100M BTU
:BOILER/REFRIG-101-S00M
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG-1,0001-1:TOM STU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER:0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT.PUMP & AIR CONDITIONER'15-30 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)
'.'TYPE IIHOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULWSTED 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 F E IS $35.0
SIGNATURE i •� r
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
(Zip)
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
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
,/
l
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $