1991, 11-15 Permit App: 91007870 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: E /2 - to!ff n
CITY/STATE/ZIP:�� ��Zeitr AC,e lG./4- ' ' '/ c> PARCEL NUMBER: (4 �� Cl a(/
OWNER: C� ,e-GL QUPg-E PHONE NUMBER: gag g - 73(c /
MAILING ADDRESS: F /7 a ro m' ..Pf . ,gc.../e Cu4-
(Street) (City/State) (Zip)
CONTRACTOR: 1.4-rifr-re S73rne SEf H° LICENSE NUMBER:
PHONE NUMBER: 53 - 83e„. I
MAILING ADDRESS: £. /2z.5- 77e6-or SLb1fR"Jd- (&s/--
(Street) (City/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 =
GAS:EQUIPMENT<100 000 BTU INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
801LER1REFR1G 101 00M 137 1>:>>> <> >'>.:::. x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
iff:,:..;;:.;;;: gmt* llt 00111 0IVEt 0!- "01S ;;;;;::::: x 12.00
.. ................
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
U.:..::: # AIRtdfort CNOti TONS x25.00
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
iftgapistootpoormoNeK4progssmiimagg.> x 60.00
VENTILATING FANS x 10.00 =
x 10.00 =
TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYPE ff H:.:..:::".: << <>E ` ONES MEM iga <'< is =
�.:;:.;:.:.::.;::: #�00E�..........:.> :�>�:>::;:::: x 10.00 -
CLOTHES DRYER x 10.00 =
x 10.00 =
.:.:::.;:::.�::.;;:..;:;:>;;:.>;::>�:.;:>::::>::;:.>;;:<::>:::>:>:>:_;:::<:<::<::<:»><::;;:.;:.;;:.;;;;;;:;.;;;:<::;:<;.>:.;:;.;:.;::.;;:.;;:;-;;;:.;:.
GAS LOG 3 x 10.00 =
MISCELLANEOUS_(NOT COVERED E SEWHERE : :::>':':: : x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
Ul,JNSTF GAS PPt.IANCE 0000 8 TU `;'' '`:;;;;: x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
x100.00-
=
AIR HANDLER<10,000 CFM x 12.00 =
AIR I•iANDLERf ,01QQ CFM , .:<:: . x 15.00 =
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