1990, 08-28 Permit App: 90004252 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Informa-tion- Worksheet
joB STREET ADDRESS: ISI Off
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 4.00 =
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 =
Ir 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
A2,00
CITY/STATE/ZIP:
5,0irV.
PARCEL NUMBER:
4.pD
OWNER: 0ohnL
(•� '�a rLr�
PHONE NUMBER:
MAILING ADDRESS:
N �ID4 S
S
of L&
(Street)
(City/State)
(Zip)
CONTRACTOR: 4hn1F
Z I
!C LICENSE NUMBER:
S+C nAA 1 L19KF
PHONE NUMBER:
9 ->;L -A039,
MAILING ADDRESS:
b A?
(Street)
wity/ttate)
(Zip)
MEOLAN�
WORKSHEET/FEE' SCHEDULE
NUMBERX
EACH
SUBTOTAL
DESCRIPTION
--r
OF UNITS
UNIT
_
AMOUNT
DUCTWORK SYSTEM _ _ _ _ _ _ _ _ - _ _ _
WOODSTOVE/INSERT _ _ _ _ _
GAS WATER HEATER -_-_-_-_--_-_--_--
HEATING EQUIPMENT <100,000 BTU _ _ _ _ _
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS) _ _ _ _ _ _ _
GAS PIRING (5 OR MORE. EACH:)_ _ _ _ _ _
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU_ _
REFRIG .501-1,000M BTU
REFRIG 1,001-1,750M BTU _ _ _ _ - _ _ _
REFRIG+1,750M BTU _________-_
HEAT'PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS _
HEAT PUMP & AIR CONDITIONER 30-50 TONS _
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE 1 HOOD (PER 12 + . nu 12 OF
TYPE II HOOD______________
CLOTHES DRYER______________
RANGE_
GAS LOG_--_-__--_-_- _-_-_-_
MISCELLA_NEOUS (NOT COVERED ELSEWHERE)_ _
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU_
USED APPLIANCE <400,000 BTU_ _ _ _ _
USED APPLIANCE >400,000 BTU_ - _ _ _ _ _
AIR HANDLER <10,000 CFM _ _ _ -
AIR HANDLER >10,000 CFM
t
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 4.00 =
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 =
Ir 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
A2,00
-�
4.pD
SUBTOTAL
I $, a6.4b
PLUS: PROCESSING FEES+ $ 25.00
ti EQUALS: TOTAL PERMIT
NOTE: MIN PE T FEE IS $35.00 FEE DUE
SIGNATURE UA
Spokane Coun Department of Building and Safety
West' 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675