1992, 08-20 Permit App: 92006659 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
_lnfornation Worksheet
JOB STREET ADDRESS: .e--/ 7Z `i S • (/) , c.' c , ' f (i
CITY/STATE/ZIP: i) C Kcu r , li, 11 r r -),C' C,, PARCEL NUMBER:
OWNER: i', n' 1 1 C (kA - b,L+ L-. I ,' 0(_ 1- PHONE NUMBER: c/ - - t --.3
MAILING ADDRESS: 1-f-�..`i S. C'il,oQ_,'• rLt Di'ek'cv)c ,i,_ft\ iVa(-'(,.
(Street) d (City/State) (Zip)
CONTRACTOR: (! ' t y�ci. i -t-' s //c ci /-, n LICENSE NUMBER: c_i j-/}7 7 yC! /'/C. ii
✓ PHONE NUMBER: j `�L/ 1
MAILING ADDRESS:
DESCRIPTION
(t-'57 S A - /V0 r1
(Street)
MECHANICAL WORK
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT 100,000 BTU (INCLUDES'
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
..:.......:.:...............:..............................................:....:.......................................
BOILER/REFRIG +1,750M BTU
:HEAT PUMP: & AIR, CONDITIONER 0 3 TONS::::::::::::
.......................................................................................................................
.......................................................................................................................
HEAT PUMP & AIR CONDITIONER 3-15 TONS
............................................
;HEAT PUMP::& AIR>CONDITIONER 15-$0 TONS::
.......................................................................................................................
HEAT PUMP & AIR CONDITIONER 30-50 TONS
...................................................
:HEAT: PUMP: & AIR CONDITIONER. +50;TONS: ` <
VENTILATING FANS::.............................................................
................................................ ........
...............................
.............................................................
<EVAPORATIVE OOLER
........................................................................................................................
........................................................................................................................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
.....................................................
.....................................................
.............................................
CLOTHES DRYER
........................................................................................................................
.........................................................................................................................
GAS LOG
.................................. . .
............................................................................
MISCELLANEOUS'(NOT'COVEI ED ELSEWHERI
UNLISTED GAS APPLIANCE <400,000 BTU
.........................................
ULINSTED GAS APPLIANCE>400,000 BTU
USED .APPLIANCE <400,000 BTU
..................................................
USED APPLIANCE>400,000 B
AIR HANDLER <10,000 CFM
AIR HANDLER >10 000:;C
NOTE: MINIMUM PERMIT FEE IS $35.00
4,01cto l c )
(City/State)
- R(t.)
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
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 =
x60.00 =
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 =
/
/ 0 . c=' (
/
r s ", 0 o
2
c, r,
SUBTOTAL
$ ., i, o (_�
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 5 ,(- C
SIGNATURE d
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675