1993, 05-17 Permit App: 93003581 Mechanical FixturesJOB STREET ADDR
CITY/STATE/ZIP:-*e-4-11-4{-)
-
OWNER: ' 7 -4"N -4 w
MAILING ADDRESS: .462--r✓tl'--
MECHANICALf ERI UT APPLICATION FORM O\3 - --35zs<I
/ �3aa
gInformation-Worksheet
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SS: 0
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PARCEL NUMBER: '/'
PHONE NUMBER' 9�P- 016
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ALP
(Street) (City/State) a(Zip)
CONTRACTOR: �%• /`. 1 .t y "1-16.-b..0_, h`
LICENSE NUMBER: y eEF%tL' 8'T /D %
PHONE NUMBER' c2°2- <7639
MAILING ADDRESS: c7•0, /-" `�911�CLno Q - 9Q€ 2/3
(Street) as (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT+100,000 BTU DUCTWORK)
lBAS
BOILER/REFRIG 1-100M BTU
igicafffigEet
BOILER/REFRIG 501-1,000M BTU
i?.�
BOILER/REFRIG+1 750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
Rat rail! . §ther a2 a1W^3
HEAT PUMP & AIR CONDITIONER 30-50 TONS
lg£S . f gO. (il >M klitiS I a
VENTILATING FANS
kW -7—r ,.,.,p,.,. _ : car
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
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UNLISTED GAS APPLIANCE <400,000 BTU
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USED APPLIANCE y<4/0�/0�,0(�0(�0�YBp�TU
itirtfatgatg-tAIR HANDLER <10,000 CFM
NOTE MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
x 10.00 =
`.-
x 25.00 =
x10.00=
/D. DD
x 12.00 =
x 15.00 =
x 1.00 =
/. DO
x 12.00 -
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x10.00 =
x 50.00 =
x10.00=
x 10.00 =
x10.00=
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
/a. o0
!i-
x15.00=
SUBTOTAL
$ ,-)7-?- DO
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_$ WWI
/pad Spokane County Division of Buildings
WestBroadway Avenue Spokane, WA 99260 (509) 456-3675