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1992, 05-21 Permit App: 92003621 Mechanical Fixtures53-D n c ONLa 'd ate. ti JOB STREET ADDRESS: CITY/STATE/ZIP: OWNER: l is (oma MECHANICAL PERMIT APPLICATION FORM Information Worksheet s' z'� �. /2 PARCEL NUMBER: PHONE NUMBER: Q. l / MAILING ADDRESS' 9Z. / (Street) (City/State) • CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Zip) (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU > )L EE # a ltB'T BOILER/REFRIG 501-1,000M BTU sountneme *DOW BOILER/REFRIG +1,750M BTU 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 .............................. ............................................ GASLOG::::::::........................................................................... UNLISTED GAS APPLIANCE <400,000 BTU • USED APPLIANCE <400,000 BTU SED "LI E` ± QOQ ETU AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE -- (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x 12.00 =)( x 15.00 =0 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 = x35.00 = x6 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x10.00= x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675