1993, 08-06 Permit App: 93006748 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: O'1// '<i, o�Q % -;-) / 6'
OWNER:
MAILING ADDRESS: •
PARCEL NUMBER:
PHONE NUMBER:
J
f 9 9,_ e 6
/ (S���titENSENUMBER:t
y/State)
CONTRACTOR: � -j
MAILING ADDRESS:11 /3z -Am
(Street)
DESCRIPTION
MECHANICAL WORK
(SEPARATE SYSTEMS)
VIIQ�?:QST0IE.SlIN:.:.S:::::. _:::: �.:::::.::..:.:::.....,:..::.:.::....::......:...:....:.
GAS WATER HEATER
GAS EQUIP141SI*IT, IQQ Aoo: ITU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
QILERIRSFf G 1:01 00M BTU v:
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
iiMPRONKIVAR900030NER
HEAT PUMP & AIR CONDITIONER 3-15 TONS
klEA.T PUMPti► IIF c0NpJTIONEl•15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
sf1�!►;I' PU:�P �:AIR CO�I�?ITIONI�R. t
VENTILATING FANS
TQ
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
jPE .HOOD>a; ;::> » ::: ;;;
CLOTHES DRYER
..tY
GAS LOG
IS,CELLANEOVS..(NQT.COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
.......................... .
l IMSYT
USED APPLIANCE <400,000 BTU
i1Yr�[!'f4-::4 fllfl�i�'11'1n���•%ihh'AAA'if1h1+1'I 2�t
ry.w...::/ i^•.:\F•: i:�i~>.�•i •rte. r7l. MMM
AIR HANDLER <10 000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
eL )4 Az_
PHONE NUMBER:
.4)6/6_ (
(City/State)
(Zip)
AJCife T1 -/109v 7 o
9 9
(Zip)
NUMBER
OF UNITS
ELECTRIC/DUCTWORK
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x12.00=
/4.00
/a,C0
x 15.00 -
x 1.00 -
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x60.00 =
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 =
r-
06
SUBTOTAL
$ .4 LIDO
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 04-e-
Spokane County Division of Buildings
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