1993, 06-04 Permit App: 93004296 Mechanical FixturesMECHANICAL PERKi(IT APPLICATION FORM ��q3-LCD-9(49
.11--3 LC D-y�
t+
Information Worksheet OO 6
JOB STAEE7 ADDRESS. 3I
CITY/$7AT.ERIF.ffi f iybo l/)! / /'2/6 PARCEL NUMBER: �y�,
OWNER: //)�? fp / PHONE NUMBER: Y -.VS
MAILING ADDRESS: r
(Street)
CONTRACTOR' ,AJ9mn /,///V
MAILING CRESS: F . 5/0311 n f
(Street)
(City/State) (ZIP)
LICENSE NUMBER: ,Ak' r c/419i/742r
PHONE NUMBER: 63V 61975-
9W LA
(City/State)
MECHANICAL WOR
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
A0
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
OPIRCSIOWISEEZP
BOILER/REFRIG 1-/OOM STU
BOILER/REFRIG 501-1,000M BTU s
BOILER/REFRIG +1,750M BTU
iigRIOPICASZtattaffaririliffEr
HEAT PUMP
'']&_AIR CONDITIONER 9-15 TONS
fitift
HEAT P{UMP�&'�AA1R CONDITIONER30-5�0rTONS
ga4
VENTILATING FANS
AP g 5 MI" °r ,sem
TYPE I HOOD (PER 12' OR 12' PTN OF HOOD)
CLOTHES DRYER
GAS LOG
PlgtgraNDERNAMMB
UNLISTED GAS APPLIANCE <400,000 BTU
IMMaggr PrASOPOSSO." .«.• ), ..:
USED APPLIANCE <400,000 BTU
VOIPPARPOWIffrI�
AIR HANDLER <10,000 CFM
.1007SigiWOOgtat: ) mY��•', `
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
XEACH
UNIT
=AMOUNT'
x 10.00 =
x 25.00 =
x /0.00 =
/A.
x12.00=
/a. Qo
x 15.00 =
x 1.00 =
c>9 db
x12.00 =
x 20.00 =
x25.00 =
^:-
x 35.00 =
x 60.00 =
x12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
>,-
x 60.00 =
x10.00.=°
;.-
x10.00 =
x50.00 =
x10.00 =
x t0.00 =
A.-
x 10.00 =
x10.00 =
?"-
x 1,0.00 =
x solo =
22-
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
',-
x15.00=
SUBTOTAL
$ ci
PLUS: PROCESSING FEE
L,,
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
��jl1CO
=$ (/
t SIGNATURE
1pokanr County Division of Buildings
West 1"03 f3roat7way Avenue Spokane, WA 99260 (509) 456-3675