1992, 08-20 Permit App: 92006667 Mechanical FixturesJOB STREET
MECHANICAL PERMIT APPLICATION FORM --
Information Worksheet
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9 D, - (0 �o (c
CITY/STATE/ZIP: S pa P W4 99aO � PARCEL NUMBER:
OWNER: PHONE NUMBER: �� O
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: `'kms" 5 LICENSE NUMBER: \0 y RT T �-t C.-
PHONE NUMBER:
MAILING ADDRESS:�40 a-5-PO4� V)Q, ,-q �9;I t I - r tom^
(Street) (City/State) - (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
IN`
GAS WATER HEATER
GAS QUti'MENT <iQO,t � t TU (INCLUt l=S
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GASp11�lNG. EA fal17L(........ <s> >>:>
... ... .... ,::::::::. �.:::::::::::::::::.::.::::::.:::::
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
M
B "ILEI/K#1=FIJI ;.1.., T .B < ` ::':><>:'<<:<
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
GAS LOG
...........................................................................................................................................
...........................................................................................................................................
M1SC.ELLANEt 11S (NQT t✓UV RED'SLSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
..USED.,*APPLIANCE>dl70tb00 S1 U.........€:>` >>>>>>`
AIR HANDLER <10,000 CFM
...........................................................................................................................................
AIF HANDLEF1:t�,00.0 ±AFM...>".
.:............:.::..::.:...................:..........:..............::.....................................................................
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT'
=AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x 12.00 =
x 15.00 =
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 =
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 =
1
/
i S• U C�
A0. U
SUBTOTAL
$ `-f 900
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $ CSO
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675