1992, 10-05 Permit App: 92008435 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet M \I eo&) s T
JOB STREET ADDRESS: a E .`S 1' as g2- G �S
Po 1'
CITY/STATE/ZIP: dkeiri (13 lei- GI 9' PARCEL NUMBER: < 1 j If 2 -
OWNER: SCA .S 6'111 1 sJ-Qr PHONE NUMBER: 9c97 ...-4A Y3
T
MAILING ADDRESS: ) 1 1 2 . TO nc�XoSC
3 gam- C �, pa k ct-te it), 99
' (Street) (City/State)!! ,, (Zip)
• CONTRACTOR. b& U 6" I C if R ii 1 C 4.1 LICENSE NUMBER: KV,t � OG 0I
/� ,S PHONE N MBER:
MAILING ADDRESS: x4`7"7 • g . UC-Ij (U' d /%tQ 0 .9 PaO7
(Street) (CI /State) - (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X.EACH
DESCRIPTION OF UNITS - UNIT =AMOUNT
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK
BOILER/REFRIG 1-100M BTU
2 I....;1: /•• / .f Y Y M
BOILER/REFRIG 501-1,000M,BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDmONER.3-15 TONS
HEAT .PUMP. & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
CLOTHES DRYER •
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
gig wow
AIR HANDLER <10,000 CFM
x .10.00 =
x25.00 =
x 10.00 =
x 12.00 =
:x;15.00'=
•x ::1.00 _`
x.12.00 =
x20.00='
x25.00=:
x 35.00
x 60.00 =.
x.12.00 =
x 20.00 =
x25.00=:
x 35:00 := >.
x 60.00 ='•
x'10.00 =-
x 10.00 =
x.50.00 = •
x 10.00
x10.00. _
x10.00;=:.
x 10.00 _
x 10.00'= "-
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x15.00 •=
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATI
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE