1992, 09-17 Permit App 92007692 Wtr HtrMECHANICAL PERMIT APPLICATION FORM q a=1 Cock a
/ - • Information Worksheet I
JOB STREET ADDRESS: <�. �j.aG D �l r T C,,-)CCU l� l 1
CITY/STATE/ZIP:-pDk'FN (, Lv P. Cl gLG L PARCEL NUMBER:
OWNER: ARTNU).' Ness PHONE NUMBER: %2 / - .7.,2 9'7
MAILING ADDRESS: -S m -•
(Street)
CONTRACTOR: iVOR -ii. ST »E/ T1/Y6 j /4JA'ez-
MAILING ADDRESS: PD•36 K /34/4/9
(Street)
DESCRIPTION
(City/State) (Zip)
LICENSE NUMBER: /SG() IPEJ /I G/'SJ
PHONE NUMBER:
�j�oAivP, LuA.
(City/State)
9c1c;)- o S9
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
:WatiDS .V.
GAS WATER HEATER
GA ,EQU#P1 IEt :<�:t;00 f O: B.1 U (INCLUDES
GAS EQUIPMENT +.100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOI'LERIREFRIG> > 0001
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
::HEAT`::.>::::MP
........::.::.;:; �'3.:;:;;::.:,&.:
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
MI
JH'
UNLISTED GAS APPLIANCE <400,000 BTU
>re
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
ANQLI=R >1 E}�000: FM<>>
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
99213-�3 /4
(Zip)
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 =
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 =
/
/0.00
/
/a.dp
,4.0o
SUBTOTAL
$ </co
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
/
=$ sec?
Spokane County Division of Buildings
est 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
PLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street)
(City/State)
(Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
TOILETS
SHOWERS
KITCHEN SINKS
GARBAGE DISPOSAL
CLOTHESWA;SHER «<
UTILITY SINKS
ELECTRIC•WATER HEATS
FLOOR DRAINS
..............
RSIN
BAR SINKS
LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE
WATER SOFTENER
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
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 =
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 =
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