1992, 11-05 Permit App: 92009780 Fireplace, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: S ' 1 9 d
CITY/STATE/ZIP: 7%/+ ' �/ i PARCEL NUMBER:
OWNER: / d GJ h e-- / y PHONE NUMBER: 9 4 `71 S 2 3 6
MAILING ADDRESS: /S /00 /4 " h ><°(
(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
I I
GAS EQUIPMENT +100,000 BTU DUCTWORK)
_]�/ vlEr{$. � � '., lY :Y'.YY: •.}?:{.i:+{ll::{YY :rh;;}�
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
..•a.?.,;h],.cF�:.:i:3.•r:.w?:.t:SSs:.4$?..{:t. k .c.v
HEAT PUMP & AIR CONDITIONER 3-15 TONS
0:010.6
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
=tab,ffi r`'�'{•Y 1 i \ ffY $ .l'..'?{l ?a4a t
•aCw •••44tis���.x?,�'•}.sn�'�:.{
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
}:ht,
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
:n..::.w. r: x...::.:.•:....:.•:..:::::..w.v:.v:G.. rxn Yx...:.{:.wv.w. n ..•..:.•:.•a . :::: }.1`
AIR HANDLER <10,000 CFM
• •Y.•� v4:i
•{n}+:{:.::Fryi:xnxv vp.}•:: '.::: :$;?%t${rvv?4>:•5,:}.;.$, 4v:'•kti$•:
NOTE: MINIMUM PERM
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
•
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
pokane County Division of Buildings
We •' 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675