1991, 10-04 Permit App: 91006517 Mechaincal FixturesMECHANICAL PERMIT APPLICATION FORM „ _ A A
Informatiorr Worksheet
JOB STREET ADDRESS: E. 752 0 L /862)-Y
CITY/STATE/ZIP: 5 P.010 f rWA 972 /2. PARCEL NUMBER: 6
OWNER: /ftO/114 S rimyvtt (F
PHONE NUMBER: ?Z2 - /SOS"
MAILING ADDRESS: E. 752 0 L./L3ERt ' 51°014'711E / G✓r9 91.Z,/�,
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
iC.aAS QUI MENT dOG
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
lQLEFUREFRiel0t400
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
waive>rca:-x¢ori.}:r.}}}ivsr;.:��r.'rwr.aii:•S'r?.-:r:::i:i>:.:•o:::Y9
:.... ... ......... e.n•:e: aws_s.e?'':�i::�!n?:'-,wr,�,wtr:
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
•
GAS LOG
:I..�SE►[U..;. 7REIaSill111€':.
UNLISTED GAS APPLIANCE <400,000 BTU
•: J4. .:M�:YI�iY iyiiiii if?ii::::}
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 C•
FM
NOTE: MINIMUM PER IT FEE IS
SIGNATOR
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00=
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 =
x60.00 =
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 =
goov
I
12. 00
SUBTOTAL
$ 22. 00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 47. 00
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675