1993, 07-23 Permit App: 93006208 Mechanical Fixtures g5z1 r 0I1ca _ UQg
-RIc e c th &s`f'A*L,s MECHANICAL PERMIT APPLICATION FORM
u3 ,e( Information Worksheet
JOB STREET ADDRESS: ��f Z0,g) v eg/9 rIec'S/ J)lz
CITY/STATE/ZIP: /, e' 'i9�,4Ie..• e_e,49 961,3 7 PARCEL NUMBER:
OWNER: ) :,hfl6/a-/IrJe PeA K i'4-.) PHONE NUMBER: J Y /s'Yr7
MAILING ADDRESS: ,/ f Ye'RA Ci2c'5 f „) - /A'Ail9c�/fA�e 'C1n 9Jd3 j
U
/44C- (Street) (City/State) (Zip)
CONTRACTOR: A 1) c�►I LICENSE NUMBER:
`PHONE NUMBER: 6 6 6, O
MAILING ADDRESS: '12/S72 g /U S/,c C'oe,t% 5 S r*/)i-r e Ldfi 97,72e5--
(Street) ity/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
x 25.00 =
GAS WATER HEATER x 10.00 =
GAS00UI0400 :NPOOM(1NGM::.:;:5;>;:. ;;;<.;;;;;;. :.;:.:;:
x
12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
x
1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
::::.:: :: :::..:...::....:......:..:...::......:...:............
x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
•isHEATIll'Mf'>&AtE't:<0t40t'C.IONgR::D::; >:;;O.::.;5;:.;;:.;;>::.::.;:.::.;:.: :.:.::
x
12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
2 0 =
tEA:;>€f'�>ulf�&1�1�t> �tl�i�f'1'ICvOI�>15 �.:::;�:.:.�:.::.::::.::.:;:.;:::.;:.:
x 5.0
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
>N EAS`;PoMw'siAtOMDt'CON OR00>:::;0.:: ;,;;;:::. . .. :;::.;.;:
x 60.00 =
VENTILATING FANS / x 10.00 = GO, On
x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
1 .00 =
TYPE II.Ht�C� ....::::::.::.:::.::.;:;;
x 0
CLOTHES DRYER x 10.00 =
x 10.00 =
FANG::.: C0
GAS LOGx 10.00 =
1 0 =
MI$G4L'i�t�Et�C7$i��1a�'CosyEREC3 ELSEWHER>=< >»>>< :
x 00
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTEDAApPI.fANoE*OO100.;,.;,w
xl 0
0.00=
USED APPLIANCE<400,000 BTU x 50.00 =
x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
`>: jut>><»�> >>> > <> >� > »> < � »<> '
x 15.00 =
AIR HANE�L�R�1i�,at3Q�:.;:.: : ::......... ....
SUBTOTAL $ 1 , j
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$14(6 ' 0
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675