1992, 05-21 Permit App: 92003621 Mechanical Fixtures53-D
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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