1993, 04-08 Permit App 93002261 Furnace, Wtr HtrMECHANICAL PERMIT APPLICATION FORM
Information Worksheet (n�
JOB STREET ADDRESS: � '9 Z 34/ hie/ gi,,,)o,) UY,
CITY/STATE/ZIP: Cep,
OWNER: a-0 -) h J% c
MAILING ADDRESS:
Dr, ' q /of
PARCEL NUMBER: Li I 4
PHONE NUMBER: 9.2 y
(Street) (City/State)
CONTRACTOR:/067 / iv4a ( C4 j>�ip C. , LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS: ET ? 8'/ clot
DESCRIPTION
�/
(Street) / (City
(Zip)
psitri- ,�1/4 7-�� � c160 K�
oL /_
State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
lea r�+yro�.•.!�,�.,yvy..`.c�,•,�.•H.,(,��•,�tr�„�.c,».�.�y�.,:�
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
nar
BOILERIREFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
raw eerm.
HEAT PUMP & AIR CONDITIONER 3-15 TONS
'.P `r......: r .... .
YS
D.•-ONE •
TOEVitiM
•ram
: .
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
1 ,t, ..::
_TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
000
CLOTHES DRYER
•
,G:'fi;, vt,n..'.'ahM'a*2•M42**%.
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
A_IR HANDLER <10,00o CFM
>i fR='A1i t:<'iiJ�`iQz3l`M>:
M+m•:C: rihtrx:C•: r:'In•.tiir. _ A.i.iiL:+:i�v+:n•}r.Q•: �P:.4in:i�i/f%r.::t4'fi:P
NOTE:. MINIMUM PERMIT FEE IS $35.00
SIGNATURE
ipokane County Division of Buildings
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
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 =
x12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x60.00 =
x
x
x
x
x
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $
PLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
(Street) (City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
CONTRACTOR:
MAILING ADDRESS:
(Street)
(City/State)
DESCRIPTION
TOILETS
SHOWERS
KITCHEN SINKS
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
GARBAGE DISPOSAL
UTILITY SINKS
rir
FLOOR DRAINS
aF
rtmc
BAR SINKS
LAWN SPRINKLER— FOR EACH BACKFLOW DEVICE
WATER
DRINKING FOUNTAIN
SOFTENER
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
SUBTOTAL
PLUS: PROCESSING FEE
NOTE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTALPERMIT
FEE D
SIGNATURE
+ $ 25.00
Spokane County Division of Buildings