1991, 08-26 Permit App: 91005311 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
nformation Worksheet
JOB STREET ADDRESS: 62,9 7 P
CITY/STATE/ZIP:7 k aw o LU, Gig ,- O (v
OWNER: 4gInQS 7dc5e2i rn ►) -
MAILING ADDRESS: -4 g
(Street)
CONTRACTOR:`
MAILING ADDRESS:.., 27
(Street)
DESCRIPTION
PARCEL NUMBER: .13559 Pm Y
PHONE NUMBER: gam' CO 7 cI
(City/State) (Zip)
LICENSE NUMBER: 07.404D-
PHONE
7.4/-PHONE NUMBER:
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
aAS EQUIPMENT<t00 000 BTU LI 3t ES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAPIPIG_
BOILER/RE
1-100M BTU
'ry8:
:B. •:J
G 50
BO`ILER/REFRI1-1,000M BTU
BOILER/REFRIG_+1.,750M BTU
• ..n.:;.s"?
HEAT PUMP & AIR CONDITIONER 3-15 TONS
.:y: - ;TON :
HEAT PUMP & AIR CONDITIONER 30-50 TONS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
MISCELLANEOUS (NOT CO EKED ELSEWHEI
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE>400•
,000 BTU
...............
U
USEDED`APPL; APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
AIR ('HANDLER >
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUR
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 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x12.00 =.
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675