1991, 11-26 Permit App: 91008179 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM q`' e r1 1
159 Information Worksheet
N
JOB STREET ADDRESS: S l 401 904WXA Dal
CITY/STATE/ZIP: 500 6"je PARCEL NUMBER:
OWN
MAILING ADD
PHONE NUMBER:
(City/State)
CONTRACTOR: R & R HEATING & A/C, INC. LICENSE NUMBER: BRHEAA*106BW
(zip)
PHONE NUMBER: 484-1405
MAILINGADDRESS: E. 1723 Francis Spokane WA 99207
(Street) (City/State) (ZIP)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
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GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG .1 -LOOM BTU
BOILER/REFRIG 50_1-1,000M BTU
BOILER/REFRIG;+1,750M BTU
ER 3-15 TONS
ER 30=50 TONS
VENTILATING FANS
TYPE I HOOD (PER :12' OR 12' PTN. OF HOOD)
CLOTHES DRYER-:,
----------------
..............
RYER` ,' --------:{_:::.:_::::
GAS LOG
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UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU_
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AIR HANDLER <10,000 CFM
:......................................................................
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
x 10.00 =
x 25.00
x 10.00 =
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:'==:
x20.00a
x 25 00::
x 35.00 = .<
x 60.00
Ix 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 =
/Q. 00
-040
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