1992, 08-11 Permit App: 92006330 ACMECHANICAL PERMIT APPLICATION FORM
- Information Worksheet
JOB STREET ADDRESS:yUy . 39k, f i tryI
CITY/STATE/ZIP:�) £j . Lo 6/9;7 PARCEL NUMBER:
-350
OWNER: 0Ji GLi en /lam PHONE NUMBER: 7(C ' i (6
MAILING ADDRESS:
CONTRACTOR: 111 lDkrI ll y
(Street)
MAILING ADDRESS: C,
DESCRIPTION
(Street)
(City/State) (Zip)
LICENSE NUMBER: lkY'/? Cf)/119/<7n2 2_=
PHONE NUMBER:
I 9 LI
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
wb668tOsitiikt
GAS WATER HEATER :::::::................................................
GAS QUIPMENT 00 000..TU QNc UOES.....
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GA
I:<INGT . &.P P
BOILER/REFRIG 1-100M BTU
EOI.LER/I EF'R
BOILER/REFRIG 501-1,000M BTU
.....................................................................................
................................................................................
BOILER/1 EF'RI,.G:1E (3a-1, '50M
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
NEAT PUMP Ari CONDITIONER 15-3 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
H AT UMP AIR CONDITION
VENTILATING FANS
EVP ;ATV`E` t
C
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
NGS..: ... ...... .
GAS LOG
MISC .LANEOUS (NOT CQVEi ED ELSEWHE
UNLISTED GAS APPLIANCE <400,000 BTU
............................................................................
ULINSTED GAS APPLIANCE 5400,000 BTU ....
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00=
x 60.00 =
x 12.00 =
�,
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x1,0.00 =
x 5610 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
___4,7,
SUBTOTAL
$ 42, G21
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
39o)
_ $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675