1992, 11-12 Permit App: 92010058 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET
PHONE NUMBER:
MAILING
(Street) (Citylstate) (�P)
CONTRACTOR: -MPT+- LICENSENUMBER:-MVHI%S- IS(bvrLC✓
PHONENUMBER: S'�S"87`f°i� i41 8,-z
MAILING ADDRESS: 30 6 C (2 p�`1 G,QdKyo�l: -t w W- �9z0�
(Street) (City/State) (zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRICIDUCTWORK(SEPARATE SYSTEMS)
GAS WATER HEATER
MI070
GAS EQUIPMENT +100 000 BTU DUCTWORK)
a°ASapIPI 4,003 r 3 F
BOILER/REFRIG 1-1100M BTU
901,MOI III , A",1 Q0A O .'
BOILER/REFRIG 501-1.000M BTU
BOILER/REFRIG +1,750M BTU
HEAriY� prAlgeg��lo�f �n a r�'s� ,s�,
HEAT PUMP & AIR CONDITIONER 3-15 TONS
ROMIM /l 41POW 40 OKS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
TYPE I HOOD (PER 12 OR 12 PTN OF HOOD)
xy
CLOTHES DRYER
AIR HANDLER <10,000 CFM
AIR WAnNaLER?yo;000.CFM 'i .
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
NUMBER
OF UNITS
)EACH
UNIT
-Go
'
= AMOUNT
X-1 0. =
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 =
x 60.00 =
X10.00 -
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x10.00=
x10.00 =
x 10.00 =
x 50.00 =
X100.00 -
x 50.00 =
X100.00 =
x 12.00 =
x 15.00 =
a
1;v,-'
E-.
(
(o•�
SUBTOTAL
PLUS: PROCESSING FE
EQUALS: TOTAL PERMIT
FEE DUE
"s3�,Oo