1993, 03-04 Permit App: 93001237 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: � ( ' 7
CITYCITY/STATE/ZIP:`19aP: c��o cam„ Q � 1 .1, b (c PARCEL NUMBER:
OWNER:
PHONE NUMBER: C? -1. f
MAILING ADDRESS:
7 I(Street) (City/State) )
CONTRACTOR: irk ti_�..r i I t.-�` ,,-. f-c' r^ tom` LICENSE NUMBER: ail' -- �- C -i SZ'
PHONE NUMBER: q� 1 °-�- c -- /
MAILING ADDRESS: L- 1 t (c t (c .�'1 o,d A<w �crF�-4 Y - ��{� iV �� C. 1299.
(Street) (City/S te) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
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GAS WATER HEATER
PM-.I.'I.`�`�.
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
41411117ff-. i7F:: .:T.".:`" :l!Ffaiit7
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
.')!'.PUMP, ts< �►IECOPIV11014... i►- (x�.;._<::,
HEAT PUMP & AIR CONDITIONER 3-15 TONS
,F,tu .. P>&tAIR;. DIT .N'ER€"1 O> & >f >
HEAT PUMP & AIR CONDITIONER 30-50 TONS
�.. T I UMP &- AtIR CON ITIONE +S0 TONS
VENTILATING FANS
:;: ;X-.
TYPE 1 HOOD (PER 12' ORI 1�2'RPTN. OF HOOD)
•.....:.........:..:.:.....::..:...
CLOTHES DRYER
•.:Y}L, n.@, i • s�vvcc�� :tiff?i
..:.''o�..�r.'-.q•.�:•..'.•.�.w'��.�.-.i.�-'<k��s...�•�":'F..::,d...<:...:u`v'w$":::^�::<>-...,v.........:.:.... v :.. ..r4:.aa✓Ai~ i"i'G•y'�:::::. .c...........
GAS LOG
!ELS- Mai
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPUANOE #.
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x12.00 =
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 =
x10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x
SUBTOTAL
$ lac,
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
�i
= $ //. GD
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675