1991, 08-01 Permit App: 91004690 ACJOB STREET ADDRESS:
CITY/STATE/ZIP:
MECHANICAL PERMIT APPLICATION FORM
Ir.,formati//on WorksheetCd-
3-7P6
ftt(D t i?) q9706? PARCEL NUMBER:
OWNER: I)fw - vvvt &i&
MAILING ADDRESS:
CONTRACTOR: f
MAILING ADDRESS:
PHONE NUMBER: / c) 4 C, E- 7 5s
(Street)
pea
(Street)
` ( 2a,f/LP ,0)4-9q/2 c
City/State) (Zip)
LICENSE NUMBER: se- A-P��cLti�T-
PHONE NUMBER: //48q- i I i 0 SC ,3 c/
f°C
/ciaa_ 4I�, li) Q9.21ar6
I(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIING (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
0-3 TONS
3-15 TONS _
15-30 TONS _
30-50 TONS _
+50 TONS
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
VENTILATING FANS
EVAPORATIVE COOLERS
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_ _
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
1
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
X 1
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 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
Spokane Coun � epartment Building and Safe
1303 Broadway Avenue Spokane, WA 99260 (5
NOTE: MINIMUM : �T FEE IS $35.00
Spokane Coun • epartment of Building and Safe
1303 Avenue WA 99260 (5
SIGNATURE
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
West 09) 456-3675