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1992, 08-03 Permit App: 92005985 Mechanical Fixtures
MECHANICAL PERMIT LICATION FORM Information Worksheet 0jMj6 s --L t�k 2�uD JOB STREET ADDRESS:.,��_y L{o CITY/STATE/ZIP: .�� /6.�9- i'iZI ZPARCEL NUMBER: OWNER: PHONE NUMBER: 7Q '? MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: .r .� `' LICENSE NUMBER: •J":t C-11 (Vc--Yr-15 I N PHONE NUMBER: ?AILING .ADDRESS LUf. (Street) (City/State) (zip) d MECHANICAL WORKSHEET/FEE SCHEDULE uj'4'--cz - % t P, NUMBER X EACH CRIPTION4OF UNITS UNIT AMOUNT DUCTWORK SYSTEM_ _ _ _ _ _ _ _ _ _ WOODSTOVE/INSERT _ _ _ _ _ _ _ _ _ _ _ _ GAS WATER HEATER HEATING EQUIPMEN_<_0_,_0_ _T_ __ __ _ __ _ _ HEATING EQUIPMENT +100,000 BTU _ _ _ _ _ GAS PIPING (1 - 4 OUTLETS) _ _ _ _ _ _ _ GAS PIING (5 OR MORE. EACH:)_ _ _ _ _ _ REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-500M BTU REFRIG 501-1,000M BTU REFRIG 1,001-1,750M BTU _ _ _ _ _ _ _ _ REFRIG +1, 75 B _ _ _ _ _ _ _ _ V HEAT PUMP CONE -3 TON_ HEAT PUMP &AIR CONDITIONER 3-15 T_ HEAT PUMP & AIR CONDITIONER 15-30 TONS _ HEAT PUMP & AIR CONDITIONER 30-50 TONS _ HEAT PUMP & AIR 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_-_-_-__--_-__--_-_-_-_ MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ -UNLISTED---6� MAN APP CE -<4G0 t36r0- -W _- 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 _ _ _ _ _ _ _ _ x$10.00 = x 25.00 = / X 10.00 = ,p x 12.00 = x 15.00 = x ) . 00 = Ise x 1.00 = x 12.00 = x 20.00 = x 25 00 = x 35.00 = x 60.00 = X 12.00 = iZ-.� 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 = -k-5-0. 0 x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ 7 PLUS: PROCESSING FEES+ $ 25.00 EQUALS: TOTAL PERMIT NOTE: M KUM PERMIT FEE IS $35.00 FEE DUE _ $ �-- SIGNATURE D S okan County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675