1991, 11-12 Permit App: 91007754 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Waftheet
JOB STREET ADDRESS:
I/,4" Z
CITY/STATEIZIP:_ 00 r i /JE
PARCEL NUMBER:
OWNER: DAA) 5; m, ZI.1 ; O A� Lcv
PHONE NUMBER:
MAILING ADDRESS: j&Z'
(Street)
(City/State)
(Zip)
CONTRACTOR: MSM INC (MARTIN SHEET METAL IN410ENSE NUMBER:MA RT IS
M170KW /C600 470 101
PHONE NUMBER:
924-8088
MAILING ADDRESSBLDG 103 SPOKANE INDUSTRIAL PARK SPOKANE,
WA
99216-1609
(Street)
(City/State)
(Zip)
MECHANICAL
WORKSHEET/FEE SCHEDULE
NUMBER
X EACH
DESCRIPTION
OF UNITS
UNIT
=AMOUNT
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
x 10.00 =
WOODSTOVE/fNSER7x25.00
=
GAS WATER HEATER
x 10.00 =
GAS EQ11PMEN,..
..,.
x 1200 =BN..<
�? l
GAS EQUIPMENT +100,000 BTU DUCTWORK)
x 15.00 =
GAS PIPING {EA OUTLET)....:::.. .
....................
x 1.00
BOILER/REFRIG 1-100M BTU
x 12.00 =
BOI.L.ER/REFRIG `7 01 : 500M BTU .
x 20.00 =
I i
QOILERIREFRIG 501-1 ,000"" RTU
BOILER/REFRIG +-l.,.715 OMBTU
HEAT PU%1P & AIR CONDI I IONER 3-i5 TONS
iiEA! r U M A:R CON0 i T i01"JER 3u 50 T OtvS
VENTILATING FANS
NOTE: MINIMUM PERMIT FEE IS 535.00
SIGNATURE
x 60.00 =
r^
x 20.00 =
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 =
X-100.00 =
x 50.00 =
X100.00 =
x 12.00 =
x 15.00 =
:SUBTOTAL I S r j r 0C�
[PLUS: PROCESSING FEE I -+S 25.00
EQUALS: TOTAL PERMIT
FEE DUE = S CS,O
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675