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1992, 09-01 Permit App: 92007069 Mechanical Fixtures
MECHANICAL PERMIT APPLICATION FORM Irjormation Worksheet JOB STREET ADDRESS: Ai V(7 / CITY/STATEIZIP5(2(. 0719 3/(0 ;l OWNER: ,.(2/C (1,%/1.4i / PIdv MAILING ADDRESS: X- PARCEL NUMBER: PHONE NUMBER ys�, i ter,/ (Street) CONTRACTOR 11:(.'Y) `1 7 . MAILING ADDRESS: DESCRIPTION v Y1;.Efl (Street) (City/State) (Zip) LICENSE NUMBER:A,O/t (()//�i7 ?cDi - PHQNE NUMBER. L -c (City/State) 71 MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) ........................................................................................................................ WOODST VE/IN ........................................................................................................................ ........................................................................................................................ GAS WATER HEATER GAS EQUIPMENT <iOO,0 ETU (INCLUDES GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU EOILER/F EPF I 101-• �5{ BOILER/REFRIG 501-1,000M BTU ........................................................................................................................ BOILEWREFRIG. BOILER/REFRIG +1,750M BTU HEAT PUMP.& AIR. CONDITIONER 0-3 TQN$ HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP &Ari G 1) )T 3f ER 15-30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS ........................................................................................................................ HEAT Ql1:Nll�&AIR CONDITIONER VENTILATING FANS .............................. EVAPO TIVECOOL TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER ............................................................................................................... .................................................................................................................... RANGE. GASLOG ::::::.................................................. _ ... ............... .................................................... .................................................................................................................... MISCELLANEOUS (NOT COVERED, ELSEWHEI UNLISTED GAS APPLIANCE <400,000 BTU ULINSTE 3.GAS.APP .IANCE >400,000 ETU. ;:: `: USED APPLIANCE <400,000 BTU USED APPLIANCE 0,000 BTt1:.. AIR HANDLER <10,000 CFM AIR HANDLER>1't,000;CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x10.00= x12.00 = x 15.00 = X 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = 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 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 1,0.00 = x50�t0 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = /). 67b /,7 a-) �.�, 0271) SUBTOTAL $ 02`" j PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ 1/<, . GO Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675