1992, 10-28 Permit App: 92009438 Mechanical Fixtures(-1./_ L b gut,
MECHANICAL PERMIT APPLICATION FORM /‘,1241
Infoi:natiorr Worksheet
JOB STREET ADDRESS: � 7 E . l >(2'{. 4-91\
CITY/STATE/ ( L ) cy99/(0 PARCEL NUMBER: 7, ,Q /
OWNER: (G RS Crl (Li( 2- PHONE NUMBER: 2- 7 Sc
MAILING ADDRESS'
(Street)
CONTRACTOR 9'2 Ur LI -16/1
MAILING ADDRESS: /i . 57/% ? l/�cy. t/
(Street)
DESCRIPTION
(City/State) (Zip)
LICENSE NUMBER: AN(6) f/%)/ 7/i' %ZZ
PHONE NUMBER:, �, -x/975
is LCw /9c)_4,
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVFIINSERT.......
GAS WATER HEATER
GAS EQUIPMENT 100 00O 3TU':(INCLUDES;;
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
SOILER/REFRIG 101 500M EITU !:
BOILER/REFRIG 501-1,000M BTU
BOILER/ EFRIG 1,0001 1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT:PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HAAT PUMP AIR CONDITION. R 15.30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TQNS>>
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II;HOOD
CLOTHES DRYER
RANGE':;
GAS LOG
r + SCELLANEOUS OT COVERED ELSEWHERE
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
AIR HANDLER!>10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(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 =
x25.00 =
x35.00=
x 60.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x10.00 =
x5000 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
-.,
J (2')
SUBTOTAL
$ 1,2, a
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
`�
_ $ 37 a)
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane. WA 99260 (5091 45R -267F