1992, 07-14 Permit App 92005255 Gas PipingJOB STREET ADDRESS:
CITY/STATE/ZIP:
OWNER:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
,)r: cL
ol�aK�1 u91-4 q9_UC PARCEL NUMBER:
2 /GK IvN
MAILING ADDRESS: /":?.2-75- Dr. ,f ,,d
(Street)
CONTRACTOR:
PHONE NUMBER:
(City/State)
(Zip)
LICENSE NUMBER:jT&:Fa.S/
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
.......................................................................................................................
Val".1 DST :i 1NSI=RT€ > > <~>< < «« > > > >> > <> > ><
GAS WATER HEATER
GAS>I�C] L�I#?I+if.>=NT�ct OiJO'Ci�<B'i'l1>flNCLl01=;
GAS EQUIPMENT +100,000 BTU DUCTWORK)
...................................................
•
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
.....................................................................................
BOILER/REFRIG F0001! 1 ;750M B
BOILER/REFRIG +1,750M BTU
HEA`r puMp &'AI.R.:oo D(T oN';ER
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP &:':AFC CO.ND)TIONE: 5'-3 t TO 3
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
......................................................................................................................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
.............................................
..............................................
CLOTHES DRYER
GAS LOG
MISCELLANEOUS (NOT COVERED. ELSEWH
UNLISTED GAS APPLIANCE <400,000 BTU
F &1cC•
d/\'A'i%AAA':
USED APPLIANCE <400,000 BTU
...............................
•
AIR HANDLER <10,000 CFM
AIRHAND`LE1151}OOOCFM
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
PLUMBING PERMIT APPLICATION FORM
Informatioir Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (CitylState) (Zip)
CONTRACTOR: LiCENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Zip)
(Street)
(CitylState)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
TOI LETS
SHOWERS::::::................. .................
KITCHEN SINKS
D IS,HAS HERS:
GARBAGE DISPOSAL
CLOTHES;; WASHER::;;
UTILITY SINKS
ELECTRIC`WA ER<HE
. ......::.:: ..
FLOOR DRAINS
BAR SINKS
LAWN SPRINKLER — FOR EACH BACKFLOW DEVICE
WATER SOFTENER
U.R
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 =
x 6.00 =
x6.00 =
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 303 Broadway Avenue Spokane, WA 99260 (509) 456-3675