1991, 05-24 Permit App: 91002863 Insertf' _i_
MECHANICAL PEfiNI`it APPLICATION FORM o f
Information Worksheet ,kQi,_r
JOB STREET ADDRESS: L) 7 eft '-3-- 6-., Z ---r._
/ / J�
CITY/STATE/ZIP:--s,/��4 vi -c. l 792V4 PARCEL NUMBER: / 527/ / 6a3i)
OWNER: ,-57-pAc +� 3� G4 L --e PHONE NUMBER: ,"...-2.- 52,/
MAILING ADDRESS: £//c // -S/ K /a ® --c G/l1-- 97
(Street) (City/State)
CONTRACTOR: ®e 47 `r'''Y1L- LICENSE NUMBER:
PHONE NUMBER:/X..? 9-- S -0/ 7'5'
MAILING ADDRESS: /g���v l/ . 5 -r 7e, f�%C. I.-, lift- "S%2c74.,
(Zip)
DESCRIPTION
(Street)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
-W DSTOV - - IN ERS':»`::
00..:;;:.:;.;:0>:_.;::;;$,;;;;;;;;;;;:.:�:.;;;;;;;;;::,;;;;:;,:_;;;::,.::-:;;:.;;;;;:;<.;;;;::;;;:.:;:.;:�:.;::::
GAS WATER HEATER
GAS EQUIPMENT <100,000 I TU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA;.OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M BT4l ."; :`'
BOILER/REFRIG 501-1,000M BTU
•BOILER/REFRIG:;1,0001 1,750M 13TU
BOILER/REFRIG +1,750M BTU
HEAr PUMP &<AIR CONDITIONER 0 3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP 8. AIR CO.NDITIONER;15 30'TONS:.:
...........................................................................:....................................................:.
..................................................................................................................................
HEAT PUMP & AIR CONDITIONER 30-50 TONS
..................................................................................................................................
HEAT PUMP & AIR CONDITIONER +50TONs:.....:..
..................................................................................................................................
..................................................................................................................................
VENTILATING FANS
EVAPORATIVE COOL.ERS...:...,>;::>;
..................................................................................................................................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II :HOOD::><
CLOTHES DRYER
RANGE.
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
......................................................
ULINSTED: GAS; APPLIANCE>400000 BTU
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
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 =
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 =
x10.00 =
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
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675