1993, 03-24 Permit App: 93001787 Mechanical FixturesJOB STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
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CITY/STATE/ZIP:�JG/,rQ 40/( qqt 0--/l PARCEL NUMBER: Q
OWNER: ^f ) / �5Lf'(�I�' PHONE NUMBER: ��� 5,7R°
MAILING ADDRESS: //-57406 X,/%.� e/C
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CONTRACTOR: Da 14C c 1 Giza
MAILING ADDRESS: \// 7// �Gri
(Street)
DESCRIPTION
(City/State) (Zip)
LICENSE NUMBER: JJANJJc Q lin
PHONE NUMBER: 2 /1�O
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
..........................................................
..........................................................
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
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BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
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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
GAS LOG
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UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
........ ....... ..............:.:.:.........::
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
A 4k to wait
(zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x12.00 =
x 15.00 =
x 1.U
00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x12.00=
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 =
/0. to
/
/0 GD
/2.0v
�•
2 . 6'
/
/20°
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 1308 Rrondwav Avenue Snnkane- WA 99260 (5091456-3675