1992, 09-28 Permit App: 92008144 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
n ! Information Worksheet
JOB STREET ADDRE S: /y/ •�� �� ��
CITY/STATE/ZIP
.
OWNER: _/tC/Slc v.5-( t�-t
MAILING ADDRESS
PARCEL NUMBER:
PHONE NUMBER: 7a7
(Street)
CONTRACTOR//:, 1/i00 (---0 77 V(/ 7 e
MAILING ADDRESS: \j)( . 6 ! . /902ld--
(Street)
DESCRIPTION
(City/State)/ (Zip)
LICENSE NUMBER: ILCI1 CZ 'I 11/
PHONE NUMBER: 2 3V: 6/C/-7 '5
MECHANICAL WORK
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSSRT
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUT ,ET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101 500M;;BTU
BOILER/REFRIG 501-1,000M BTU
SOILER/AEFRIG 1,0001 1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP &AIR CONDITIONER::O 3 TIONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER:15 30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIA CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLER$
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE 11 HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED. ELSEWHER
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS`APPCIANCE>400 000 B`TU
USED APPLIANCE <400,000 BTU
USED APPLIANCE>400,000'BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM;
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(City/State)
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x12.00 =
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 =
x1,0.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/% d?)
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SUBTOTAL
$ 3( CD
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
Wast 1 Broadway Avenue Spokane, WA 99260 (509) 456-3675