1992, 06-29 Permit App: 92004781 Mechanical Fixturest4S-6V-t, Q°vim
JOB STREET ADDRESS:
MECHANICAL E'ERMIT APPLICATION FORM c\2"` L4 140
Informal/orInformal/or Worksheet
CITY/STATE/ZIP:.: •P
OWNRa-/ G�/pe e e -
MAILING ADDRESS: -{‘/d S 4 - [VA/
AAJ
PARCEL NUMBER:
PHONE NUMBER:
V
(City/State)
,
CONTRACTOR: 5-e <' (Street) LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
541 9-rCD
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
. .;,�is..r:.::.:::.:,
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTL ::
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
..................................
.................................
HEAT PUMP & AIR CONDITIONER 3-15 TONS
:.:..................:...........:............:::..............:............:...........:.:............:...............
UMP >AIR CO DITTO 1EI `t5 t ONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
E: EA `P MP``` 1 IR:: t I IONE t'450 ONS
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,00 CFM
NOTE: MINIMUM PERMIT
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00=
x12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x60.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10:00 =
x 10.00 =
x10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
I
1,0
t
I ..
I.
i
•
10
SUBTOTAL
$ 33
PLUS: PROCESSING FEE ..
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 5.6.00
Spokane County Division of Buildings
est 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675