1993, 01-13 Permit App: 93000182 Mechanical Fixtures3 $"' MECHANICAL PERMIT APPLICATION FORM 9' l U 3 -- 2_
��e' Information Worksheet
JOB STREET ADDRESS: N 3 5/7' ij PO -1C . D
CITY/STATE/ZIP: SPDX¢/'1% E 9, ZJ Z_ PARCEL NUMBER:
OWNER: /91) CDt v%S ,f-• PHONE NUMBER:
MAILING ADDRESS: S?.9-141 "L_
(Street) (City/State) (Zip)
CONTRACTOR: T. N. lira CT LICENSE NUMBER: 77&n/77 7f'Qg7 B 1
2520
S SNE83, WA.�PHONE NUMBER:
-0504
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 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
RAVE .
Y {
HEAT PUMP & AIR CONDITIONER 3-15 TONS
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HEAT PUMP & AIR CONDITIONER 30-50 TONS
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VENTILATING FANS
e Y.
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
'f.
UNLISTED GAS APPLIANCE <400,000 BTU
.vny}'M' •:: } '•2N :+:••1+:Yf4Y f:fq^'^S+y'::h, V •nw•
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
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A I� �y.1{ l'•�, ■w, AA }w!�Mk>}r: 1 l ::!:}.}:�i�\•..:}.���;{<•}h., �'�}vy
I.�>....1�1...'t.;IT.;'�> •'���:Y:a:TI::}�!:}:•::: xi::/n;•�},}:,' ....... :..+::'•n;}: }:v :^i ...,:'J..;.;y;:
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE ,st1/11113
(Zip)
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 =
x35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x25.00 =
x35.00 =
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 =
x50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/
/
11
/
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 12 tap
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675