1992, 02-21 Permit App: 92000965 Mechanical FixturesMECHANICAL PERMIT .APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: S' ?3 / 7 /2I� / SSA
CITY/STATE/ZIP: 0 PARCEL NUMBER:
Y
OWNER: t" (Cif PHONE NUMBER:
MAILING ADDRESS:
(Street)
<=7())
CONTRACTOR:
MAILING ADDRESS:
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5LZC-7121C iv
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DESCRIPTION
(Street)
(City/State)
LICENSE NUMBER:
PHONE NUMBER: '%Fa
/7;k/ r -;#,-(Atz.iy
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REF;1416G11-_ 100M BTU
BOILER/REFRIG 501-1-,000M B_TU
BOILER/REFRIG +1,750M BTU
HEAT PUMP 81 AIR CONDITIONER 3-15 TONS
HEAT PUMP 8& AIR CONDITIONER 30-50 TONS
VENTILATING FANS
..-.,-.... ..-........rr • '-iiri:......-.: �::-.........r �F : -::: } :• :v:::::x: r:iv�:3'ff-v'TYI.rB;::x:-:TiY:
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
•
CLOTHES DRYER
GAS LOG
UNLISTED GAS APPUANCE <400,000 BTU
UL IN: :: : GAS ,. •LIAN SIX} tom'..._ <
USED APPLIANCE <400,000 BTU
USED:::: AP.:::UA�1GE:�t�oc��:::
AIR HANDLER <10,000 CFM
AIR'HANDLER >1 0,000` CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
Z1/) 4i JP
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x 10.00 =
<Fc11.Q9.-
x1 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 =
t2• 0 r
/
.v C.
SUBTOTAL
$ L3 . DO
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
7y
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675