1992, 11-18 Permit App: 92010146 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: S J/ Pi e_r-c-e_ p
CITY/STATE/ZIP: EQh rwA 1 r PARCEL NUMBER:
PHONE NUMBER:
Sp ak 2tJ�
(City/State)
LICENSE NUMBER:
PHONE NUMBER:
9144
OWNER: l�A
MAILING ADDRESS: 5. )16.1.-1 r c
(Street)
CONTRACTOR:
Vt'/f4
MAILING ADDRESS: ✓u/
c7 ) .a L
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
::::....... ............:...:.............
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
•^::.v':r. v<.•:c:a}z;;,t4se,;::::.>.::::{::::.::•:rov{,:•:4.ww•{:::...:y:..y:...,.:...
AS
:4X.:4::•}:v:}}.}}}:4%•}:•:4:•:i•}:4}}} :•.{i..n... r....v.::?}}.:•{:•:•4{{ii?
BOILER/REFRIG 1-100M BTU
•:BOLEW ETi: :3/!:< 140.0
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
1✓ONQITI3NERSTQ[fi
HEAT PUMP & AIR CONDITIONER 3-15 TONS
tclJ�l1#;i:lk7t`'•
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
:IONEB::+5t •;T• . {
... :..... .:
.. ...................;..-........::::::::::::::.::...v::::::v :}}.::v:•:}}:v;
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
r''..............t3}?i?;n:..w..:.w,.�f:i.
UNLISTED GAS APPLIANCE <400,000 BTU
.::: }....}::{••. �:::{v•}::}}::::..::::iii:::::}:': �..:':..•}:}}i �..: ..:::: �:::::.......
USED APPLIANCE <400,000 BTU
'ak:aff'Ia`i`i A i!Yic:K:iti:;EC}':.'i�iliw'rii::r.:•r.::;r::;
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE 1�
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
1.000 =
x12.00=
x 15.00 =
X 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 12.00 =
x 20.00 =
x25.00 =
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 =
x 10.00 =
x50.00 =
- _ �l1 o�
K /
/ • 0-0
r
2, W
•
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$ D-5. tro
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ So,'r°
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675