1992, 09-24 Permit App: 92008025 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: ) .5--) SCJ l c1L8
CITY/STATE/ZIP: 5/46 hew! &. \)J A a g ao 6 PARCEL NUMBER:
OWNER: Pa I r \-0.y t PHONE NUMBER: 9.. C - C'/ 9 y
MAILING ADDRESS:
(Street) (City/State) (Zip)
• CONTRACTOR: CO /h "/ 002-7 jti B. LICENSE NUMBER: Co - /'•c -o l
PHONE NUMBER:
MAILING ADDRESS: e l/6 i6 H10'1,T90*'ex.y . c/3 -5130 c tJ,a q ' .2o
(Street) (City/State) gip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
�.�• .1 b`�► • „:'�• x 25.00 =
!i•4vC4:.tihri'.vvS4:�.JAC7v\vH{w`.4•
GAS WATER HEATER x 10.00 =
C,77:71 >.,,,mmiitm 6 64.6 '`''s� �:.M �� < x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
} gr ,' >;{.r{: f {, „q}>}i:';,',9;A:>:,. 3�' `+.'� .x 1.00
= ..
}�3c��S����H „i ck.,.,..,�n3:st'tu;;;,}r>.{..h,:.fc� ,�',}�,�:h'a. . .' � • .;..
BOILER/REFRIG'1-10,0M BTU x 12.00 =
�����,�. ep; RD, <?� �h}< • x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
LONfifft,b7a. 0:41,1. 0,019:2`;‘
x 35.00
BOILER/REFRIG+1,750M BTU _ x60.00 =
fi
kr,".,;,. N ., `t� � � ��d g ><:<v: :x x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00
53024 a agiD5 x 25.00
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00
frtAPIZIP• Vagearo.:1:4)4,25010, ,`Y:X z tr, x 60.00
VENTILATING FANS x 10.00
gg2C
:
TYPE I HOOD(PER 12'OR 12' PTN. OF HOOD) .x 50.00 = •
A 6 =°a N ''< Y ; .{} < : 2 r 4 x 10.00 =
CLOTHES DRYER x 10.00 =
-'0710 x 10.00 ._
GAS LOGx 10.00 =
l QW'", .•...•a •} ..;. x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU • x 50.00 =
} 'rfi r,,,��} ; .} x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
;7'O\•rvv:.vx{y. •%'}::iHr f+r ,+�n fx f+}.witw.w:xvh :{x
KOZAI.# , 1.G ,� � ,OOw . ;; , .• x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
�ynx�} +o-*vv; „wn�rv..:x+>.y�rx{vJ^'�/..�4/•S�H?��y+*w� fi•;y. fiti ,r .i Y+;�.,}}};r h't?• -
�4.F1:': 1� [+1: 4:rO'+e�:#: �!4:4�nt.:0x4•v..•. :'CO'.v6'21 £:'to3n5. x 1fi:1> x 1 5.00 =
•:nn.:...:......:....:.•.:nv...n•:}.fi+nvn...n.vvfi:}:.v \\v:.�tA.�+••..•nvk•} .},.,�:}nl .rk•:vfi+',i'�+xnvvvvv..
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ ••
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675