1994, 10-06 Permit App 94009895 Lawn SprinklersPLUMBING PEknAIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: T i/vr 5Pbic:-Av
CITY/STATE/ZIP:O ,cam 4 1,v74- 7? 2 (,. PARCEL NUMBER: 7 E. frlr/1:
OWNER: in tAi C ern G MAILING ADDRESS: ADDRESS: •elD�� 3:5 h /9- %j`6•-0 52
- (Street) (City/State) (Zip)
CONTRACTOR: 2 /tc -, Nam. c/4.- LICENSE NUMBER: 1\I6 P_ T)-I 8,9
q 2'1'5
MAILING ADDRESS: -1 o i sP.
(Street)
PHONE NUMBER: 6 a3- Jc4,c,
PHONE NUMBER: . 7) . G72/ 65. /5
sPo r 11-7s) L Imo n6
(City/State)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
TOILETS
SHOWERS
•
KITCHEN SINKS
GARBAGE DISPOSAL
UTILITY SINKS
FLOOR DRAINS
BAR SINKS
•
LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE
WATER SOFTENER
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
3
SUBTOTAL
$ ' -. ''=
PLUS: PROCESSING FEE
+ $ 25.00
[EQUALS: TOTAL PERMIT
FEE DUE
-3'.
= $ .--'s .
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
MECHANICAL PERMIT APPLICATION FORM
Information Nori.;ieet
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
CONTRACTOR: LICENSE NUMBER:
(zip)
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GiS:l3,IF?MENT`f 0' #):0'3:: N:;:L 1#)s
•... ....::.�:.::.::. ,{:., �'isle•t.:.:G.v:�.:.riY:V
GAS EQUIPMENT BTU DUCTWORK)
.4x. rii1}i•Qii::{::i:i:4{tiiiJ::{:?�::tr n}..:Y{:%i±:iY:<iL•:i4::.'
GAS€�IPING�:�1r3T ��<>{;{:<.{:.,«:.:<:.::.;:�.:.»:::Yt»>,�>::<,.;:
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
.•h4•::.vvvv:•A:%wrhxw•ri•.,•::wnv:.C::::::.:.vv. ..... vriv`.i;G.'•
HEAT PUMP & AIR •
CONDITIONER 3-15 TONS
P. &• AIR CONDITIONER 30-50 TONS
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
:'r :.'•'.i'.:i i:i?iiiii'i i:i:>c[iiii i'::.:iM+
•
CLOTHES DRYER
GAS LOG
;1[kSGELLigNt7SjI:O COEREi:LS1lU
UNLISTED GAS APPLIANCE <400,000 BTU
IJLIN$TEt S.AF'p);(A(V. Ek 4Q' Of): tIJ
USED APPLIANCE <400,000 BTU
JJ'S D P ?'L1A'N ±k (I' 00Q
AIR HANDLER <10,000 CFM
AIR:: ANDI ER >10,000 CFM ::
NOTE: MINIMUM PERMIT FEE IS $35.00
- PP)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x 10.00 =
x12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
4
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
- $
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675