1992, 09-17 Permit App: 92007740 Stove, PipingJOB STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
V7//
CITY/STATE/ZIP: h0
OWNER: O E /e
E'f
MAILING ADDRESS:
gu'r°11v42A.4,64--5-442-44
gip) C
PARCEL NUMBE
PHONE NUMBER:*6-S VVV- SZY— 4$71
(Street)
(City/State)
• CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS
GAS WATER HEATER
NUMBER
OF UNITS
GAS EQUIPMENT +100,000 BTU DUCTWORK)
r^ r++
f6F € �5 , � : qr fyI~�':
BOILER/REFRIG 501.-1,000M`BTU
BOILER/REFRIG +1,750M BTU . •
HEAT PUMP & AIR CONDmONER.3-15 TONS
HEATPUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
TYPE I HOOD (PER .12' OR .12' .PTN. OF HOOD
CLOTHES DRYER
GAS LOG``
UNUSTED GAS APPUANCE <400,000 BTU
USED APPUANCE <400,000 BTU
AIR HANDLER <10,000 CFM
arm 4„Waffo.W
X.EACH
.. UNIT
x10.00 =
x25.00 =
x 10.00 =
x.12.00 =
x.15.00 _
x X1.00 :_
X.12.00
x 20.00 =
x 25.00. `=.
x 35.00 =
x°60.00 =
x "12.00 '_
x 20.00 =
25.00 =
X 35:00
x 60.00
x 10.00 =
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 '=
= AMOUNT
•
•
•
r �
•
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUR
SUBTOTAL
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
pokane County Division of Buildings
to AAA A'.a.>....• n__i._.__ to/A //*AAt ..-.t it.t.....
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