1991, 10-04 Permit App: 91006516 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM QQ
Information Worksheet �.t)
JOB STREET ADDRESS: F 13 1 5 Sc to r c7 BS 1-47
CITY/STATE/ZIP: 5 PbIGIAAvc wig - 4'7(2 i 1.- PARCEL NUMBER: M.6-) - 05/7
OWNER:)ALC-r-736*t-w,v0A i�P•41 PHONE NUMBER: 9a*.efc.9Si
MAILING ADDRESS: C 131 5 5-tAfro PD 1G An.e. w Wk . 4 ig.,1 --
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER.::::.........................................................
........................................................
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
6OU EWREF;. ' 4 1- ,5kM S
BOILER/REFRIG +1,750M BTU
:HEAT
HEAT PUMP
&A A4IIDIITONNER
3-15 TONS
:jx:.s}:s:;.X.yp:��,�r}X:v}•:.s:}Y.-•...:xvnv}..+.•.•.:.::::..::.::�(i�.i•.�::.r{.tii::r{n1�i'!s�:y�.:.v.+::�}:.;::,}:'l:.:i:::
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
RA
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TY I H
CLOTHES DRYER
GAS LOG
MISCELLANEOUS T COVERED Ek N
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
_# S AANCE.>>.: "00WEETV
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
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 =
x25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675