1992, 08-20 Permit App: 92006666 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM --
Information Worksheet
JOB STREET ADDRESS: •S • '41 •.3 (...); )ers ,
(o(o co (0
CITY/STATE/ZIP: e iN-cA v112-- 99c(0 PARCEL NUMBER:
OWNER: (-----c&v-Nci..k. liDo
MAILING ADDRESS:
PHONE NUMBER:
CONTRACTOR: 60r..Ztj-S
(Street)
MAILING ADDRESS: D. D. 'trbo
(Street)
DESCRIPTION
(City/State) (Zip)
LICENSE NUMBER: 'J-/(Jc.. H
PHONE NUMBER: 5----.‘S" 71327
-ypv C9'3,11
(City/State) - (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
i001LEP/REFRIGT4001:41:'-7.501%STU
BOILER/REFRIG +1,750M BTU
:.HEAT.PUMP&AIR CONbITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN..OF HOOD)
TYPE II HOOD
C LO TH ES DRYER
GAS LOG
r7:00(AANDUStiOlfbVtAb•ELEW1-itt4'
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
iAIR HANDLER >10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
x 25.00 =
x10.00 =
x 12.00 =
x 15.00 =
x1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x10.00 =
x10.00 =
x 50.00 =
x10.00 =
x10.00 =
x10.00 =
x10.00 =
x10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/0. C)()
/aQ• o n
SUBTOTAL
$ 024,1 00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL. PERMIT
FEE DUE
=$
SIGNATURE _.---")&d..i40,1,4,3)424-7.
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675