1991, 12-02 Permit App: 91008286 Mechanical FixturesdiVAtiA va
5'\P`C..5 Np
ti MECHANICAL PERMIT APPLICATION FORM G `, 82' ���,
Informationry�Worksheet t
JOB STREET ADDRESS: qS�/ 7 S- i 27xi-&4'/ ..,v41-�'
CITY/STATE/ZIP: %2, 6PARCEL NUMBER:
-! /
OWNER: �� A? eel/1//q'
MAILING ADDRESS:
PHONE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
(City/State) (Zip)
LICENSE NUMBER: ,-T� ) ?Z
PHONE NUMBER: �o�`% 5'
DESCRIPTION
(Street)
(City/S ate) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS:: I .>M :><1 t ' 3 >_--:-_'IN> -`=.•�:.t S« <
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
TirtkalifettaifiltileiVi
BOILER/REFRIG +1,750M B_TU
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f.:+.;a�-FF-�#��t'�4stFi.�v�.�i���.-'.-'�i.:'c'v..l�.�C'.+mti :[•4�Mfi- ,��.f3�i'-}i:'e
HEAT PUMP & AIR CONDITIONER 3-15 TONS
Tairawardia
HEAT PUMP & AIR CONDITIONER 30-50 TON:
VENTILATING FANS
:E R s�-{�� (t- R • .{{:-}J },:L^Y l` � •:•.�••.-•:ii .ti iii
---------------r;xy�
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
................
.1. ....... . ..... -....-...-,..------
GAS LOG
7SCa#,15-(N+- £fl...ER..: -..:: .:- -
UNUSTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPUANGE ,000 BTtI ;.........
AIR HANDLER <10,000 CFM
AIR: HAND ER 10,000 CFM
NOTE: MINIMUM PER .W FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
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 =
/•c
/,
SUBTOTAL
$ ,.' .
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 3� d --c)
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675