1992, 03-06 Permit App: 92001339 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
I4 "7 lir lC
• PARCEL NUMBER:
PHONE NUMBER:
41C
(Ci State)
LICENSE NUMBER:
JOB STREET ADDRESS: F
CITY/STAT IP:
OWNER:
MAILING ADDRESS.
CONTRACTOR: IS d P
(Street)
4 b.
(Zip)
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-10OM BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS �yy
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
•:!+tiI41.f (?4; i:;�,I?L•
GLrI 4:011: ?
UNLISTED GAS APPLIANCE <400,000 BTU
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(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 =
=
g •
Jt
'x60.00
12.00=
x 20.00 =
x 25.00 =
x35.00 =
x60.00 =
x 10.00 =
x 10.00
x 50.00 =
x 10.00 =
x10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/
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