1992, 12-08 Permit App: 92010730 Mechanical FixturesJOB STfbRES
CITY/STATE/ZIP:. _ :.,'Q PARCEL NUMBER:
OWNEF#:.:.. 5 .�(i . PHONE NUMBER:
.•z,." liy
(Clty/State) (Tip)
LICENSE NUMBER:/,r/1:/<1:)._./-
•-/- / 9/ a P
PHONE NUMBER: L/Pv2' 7...?$
• MECHANICAL PERMIT APPLICATION FORM
Information Worktheet
•
aye � 2/? 37 17I
MAILING ADDRESS:
CONTRACTOR:
MAILING ADDRESS: / .i
(Street)
(Street) • (CIty/State) (Zip)
`MECHANICAL WORKSHEET/FEE SCHEDULE r,
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS),
04. 40:1+. R3n• y » yr :S<x.YN:..>,;.;...;
.�.. .....ham`: Y it �ii��.:.
GAS WATER HEATER ' 1 Aw4ri-`tie , ,wt
C jam' .4 /(�(/���'•(Jy���y�f t }. q fa?2
GAS EQUIPMENT +i00,000 8TU bUCTWOfK)
1 :A. •x.yw:vn:•
GAS PIPIN (E/C OUTL Y �� 9t:,,,,,,,f165. � .: a .'l :'cs��
BOILER/REFRIG 1 i00M RTU' " '
t�Oli.4#ti0 f-� w ��E Q;�<, i
BOILERIREFRIG 501 -1,004M fTU.
BOILERIREERIG +1,75oM 13TU '',:','•••4 . •..
fitiiAiriV swim
HEAT PUMP & AIR CONDITIONED 3 i5 TONS
HEistN:qtiA;At O•pang:w»Y814bT s'.:.
IS{*;..`:'
HEAT PUMP & AIR CONDITIONEI•i30-50 TONS
AVATAIIMMICIVN
VENTILATING FANS_ '
EvAmmoV Lal
TYPE I HOOD (PER 12' OR 12' FTN. OF HOOD)
may::. :
1_ i PE :YC �1' hood is d54 • ; •iii.,�::)Y>:s:Y; '.i�::i'�, r $
,. ... .�: .. ,,..:... ..{..:?...ria.>i;%. i .........
CLOTHES DRYER
GAS LOG
MISCELUINEOUS (NOTt�tDLSEWNI
UNLISTED GAS APPLIANCE` 400,000 BTU
ULINSt.,o GAS APF .LIANC 06,000 t4TU< 3 ';
USED APPLIANCE <400,000 gTU
USED A f'1JAN E f
AIR HANDLER <10,000 CFM
AIR FHA14641Eq9f gip:;,
r T }£
•i4.'
NOTE: MINIMUM PERMIT F E IS $35.00
SIGNATURE
NUMBER • g
OF UNITS
‘ X EACH
UNIT . `
ie AMOUNT 4
x 10.00 ••'. '
,
x 25.00 s
x 10.00 •,' •
/ O c, -Q
x 12.00 t r�
1,12._.2,__„,, � <'
X 15.00:':i
�'
'; ___IL
x' 1.00 '' k.
t` , 0-0
x.12.00 - ••4
x 2o.60 s ia
e ,. , ' ',
x 25.00 • • •
x 35.00 in •: t
x 60.00 ,a , i
x12.002.4
x 20.00 4.
x 25.00 2)='
x 35.00 IV'
x 60.00'
x10.00 .,
x 10.00 ,E,_.
x 50.00 a ;.'
x 10.00 a ;
x 10.00 a t(
x 0.00 .:
x 10.00 1
4,L' • i l
-
,
•
1_... -
L
.°• ,. 'lei
IL, _ Ir
?y,:.,,t� •W °-,IA.
•
'
, �.."
s__ -i
,;a
ibik..,,s! „•,,,;4/.4's "r
•..
.z
X 10.002'+++`;►!
' k 50.0014
1,.`
x100.00 re 'r
x 50.00 e
x100.00 It ; ,
x12.00 ge'.,
x15.000"SL
,•._
SUBTOTAL
$
PLUS: PROCESSING FEE_,+
$ 25.00
EQUALS: TOTAL PERMIT i
;4 FEE DUE. •
.S
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675