1990, 01-02 Permit App: 90000003 Mechanical FixturesJOB STREET ADDRESS:.
CITY/STATE/ZIP: • loA;-
MECHANICAL PE IT APPLICATION FORM
Information Worksheet
lIvU S. VhiRi A44.1
PARCEL NUMBER:
OWNER: MATT l -14-A4 l.ev
MAILING ADDRESS: 5,..
PHONE NUMBER: 9 r 7-/ 7yy
(Street)
CONTRACTOR: Sert 1 l H hte-ATIN-
rhp cewpt LICENSE NUMBER: Will Ave.5 14 as set 3"
(City/State) (Zip)
MAILING ADDRESS:
PHONE NUMBER: .3c?*.. t d
(Street)
MECHAN;
DESCRIPTION
DUCTWORK SYSTEM_ _ _
WOODSTOVE/INSERT
GAS WATER HEATER _ _
HEATING EQUIPMENT_ <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C
REFRIG 101-500M BTU_
REFRIG 501-1,000M BTU- -
REFRIG 1,001-1,750M B'U _
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
/ d4'€ c
( ity/State)
WORKSHEET/FEE SCHEDULE
-NUMBER X EAC}U
OF UNITS UNIT
Ame
VENTILATING FANS
EVAPORATIVE COOLERS- - _ _ _
TYPE I HOOD (PER 12_ ' OR 1.2' PIN. OF'HOOD)
TYPE,, II HOO.D... _ _
.. _._
CLOTHES' DRYER:: �,..
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU_
UNLISTED 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
c-Isde., 7
(Zip)
= 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
NOTE: M N UM PERMIT FEE IS $35.00
SIGNATURE
Z
SUBTOTAL
$
--
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ t/9
S okane CountyDepartment of Buildingand Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456.3675