1992, 12-03 Permit App: 92010601 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
/l Information Worksheet
JOB STREET ADDRESS: /V. I' /) �
] KL
CITY/STATE/ZIP: ). ii )/4 / 9z/ z- PARCEL NUMBER:
OWNER: k13/')h i)o (hij PHONE NUMBER: 9,,?`>'�_Y3_3
MAILING ADDRESS'
(Street) (City/State) (Zip)
CONTRACTOR: lk1""CD /9/ c LICENSE NUMBER: )Q)/ CfW7 X/? Z:
PHONE NUMBER:b3y/ (Z9-2,s--
-2_
MAILING ADDRESS. G S /�_
DESCRIPTION
(Street)
Vp�J L
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
`WOODSTGVE/INStT...
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU`(INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA O)TLET)
BOILER/REFRIG 1-100M BTU
BQILER/REFRIG 101:--;500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER AEFR G 1,0001 1,75oM BTU
...................................... .
BOILER/REFRIG +1,750M BTU
HEAT PUMP &AIR.CONDITIONER:O 3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP &:AIR CONDIT`IONER;15 30 TONS;:
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & Alp CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE` COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
.TYPE II HOOD
CLOTHES DRYER
RANGE `
GAS LOG
MISC L ANEOUS (LVOT COVERED ELSEWHERI
UNLISTED GAS APPLIANCE <400,000 BTU
..........................................................................
ULINSTED GAS':; APPLIANCE >400000 RTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM:
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
/4)
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
•-,.,
x10.00=
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x12.00=
/7ev
/-,c�
��Kin
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x1.0.00 =
x 504.1)0 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ `
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
hh G�
_$S/ /. a)
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675