1992, 08-20 Permit App: 92006662 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet y ��
JOB STREET ADDRESS: %...) . f �� s' 6p f °J
CITY/STATE/ZIP:--5P°Kcav-1-e_ '_t:?f4 q�l�/a PARCEL NUMBER: `1 J a ' /4ti�Ci�3
OWNER: (r S 1-71 Q -f-c h €. PHONE NUMBER: iia CP - 0(o O-7
MAILING ADDRESS: (0 sn" 0
(Street) (City/State) (Zip)
CONTRACTOR: (.0�/u,X S LICENSE NUMBER: l�j/i��T� , Com- I 010!
G PHONE NUMBER:
MAILING ADDRESS: 2 U 6 UX (/.4(0A -SPo . , CoIQ
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOoD TgV INSI_F't`....::::»>'«'<:
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU.(INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
........................................................................................... .
GAS::PIPI
..::::::::::..:...........
BOILER/REFRIG 1-100M BTU
......................................................................................................................
BOILI'•=F /REFRIG:1<01:--500M.BTU
BOILER/REFRIG 501-1,000M BTU.:::::...........................
............................................................................................
.....................................................................................................................
BOILEl /REF'RIG.1.:,0001 1,750M
..........:................:..............:........:.....:.....................:........................................
BOILER/REFRIG +1,750M BTU
........................................................................................................................
HEAT PUMP.&.AIR NDITIONER:0-3 TONS......
.............................................................:..........................................................
.........................................................................................................................
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP: &..A. IR CONDITIONER .15-30 TONS
......................................................................................................................
........................................................................................................................
HEAT PUMP & AIR CONDITIONER 30-50 TONS
..............EAT.........................................................................................................
H;PUMP AIR SCD IDITI
VENTILATING FANS
.........................................................................................................................
EVAPORATIVE. OOLER
.......................................................................................................................
........................................................................................................................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
.........................................................................................................................
CLOTHES DRYER::.:...................................................................
...................................................................
GAS LOG
ISCE(LANEOUS (NOT COVERED ELSEWHEI
UNLISTED GAS APPLIANCE <400,000 BTU
......................................................................................................................
ULINSTED SAS APPLIANCE>400, 00 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE>400,000:BTU`
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
gca I - /rOa
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x 12.00 =
x 15.00 =
1
x = 00 .
x 12.00 =
x 20.00 =
x25.00 =
x35.00 =
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 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/
/0. 00
/
/o?. O( )
A
d
� 0
SUBTOTAL
$ c9ci 00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 4?
SIGNATURE 1t)'7,''
Spokaane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675