1992, 04-15 Permit App: 92002538 Mechanical FixturesJOB STREET ADDRESS:
CITY/STATE/ZIP: 6) r ' e'i
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
.Q '4- 0-/ ()
OWNER: e''\c. e
L- A . PARCEL NUMBER:
PHONE NUMBER: 92..2-6 7 7 z -7
MAILING ADDRESS: l O c>s
(Street)
(City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSER'T'.:
GAS WATER HEATER
.......................................................................
GAS EQUIPMENT <1 ?0r000! BTU (INCLUDES;.:.::::>:;:
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
..........................................................................................................................................
BOILER/REFRIG 501-1,000M BTU
................................................................
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP &: AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT
..PMP&.....A....I..C...
ONDITONER.+..5
•
VENTILATING .0.....T...0....N....^......::.:.:.:.......>.<.'>.::..:..:...;.;.:.:.
FANS
............................................
...............................................................
EVAPORATIVE COOLEI :S:::;:`°:°.`
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE' II HOOD
CLOTHES DRYER
RAN
.....:..............
GAS LOG
MISCELLANEOUS (NO COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE400000 BTU;:
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400'000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER.'>10,000 CPM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
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 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675