1993, 04-12 Permit App 93002383 Lawn SprinklerPLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 7 0 ;-% S_ Fe Ws
CITY/STATE/ZIP: Spok9&+.?, ciLl 99 ao4, PARCEL NUMBER:
OWNER: Sue S,T:i f il PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: .9n koi im Pre&`e `/' or LICENSE NUMBER: SACK =0:73 m C
PHONE NUMBER: Lfa'3,S3 /
S,nvkh e , ("--ct 9'7a°-7
(City/State) (rP)
MAILING ADDRESS' ! a833 �1'✓�
(Street)
DESCRIPTION
TOILETS
RSIIUI�S ,
SHOWERS
SBA €Her
KITCHEN SINKS
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
GARBAGE DISPOSAL
UTILITY SINKS
ges�.
FLOOR DRAINS
r: F
BAR SINKS
, S'
LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE
WATER��SOFTENER
1Rli:rYd6u
DRINKING FOUNTAIN
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 =
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 =
g`=
NOTE: MINIMUM PERMIT FEE IS $39 p0
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
+ $ 25.00
=$
Spokane County Division of Buildings
..t__. 4 non_ o.....a..n..._n><gniio Rnn_kana WA 9926_01509145673675-,.__,_
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
i IF)
(Street) . (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
gratrillaiatada
GAS EQUIPMENT+100,000 BTU
PIPING rat
BOILER/REFRIG 1-100M BTU
rBtlia:aglaa
DUCTWORK)
BOILER/REFRIG 501-1,000M BTU
BOILER_/R_EF_RIG +1,750M BTU
emoy.. >: {fix
0.
CONDITIONER 3-15 TONS
- HEAT PUMP & AIR
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING
y� FANS
!y
��r:/N�:/iiv.Gri%n..MMttC.J:oRrvGv<wnWmmuv`:
TYPE I HOOD (PER 12' OR 12' PTN. OF
CLOTHES DRYER
N
GAS LOG
kt) CBI:'> A t§. ( (?'(E Y A S i,i n
UNLISTED GAS APPLIANCE <400,000 BTU
CIt�15T 4AS 1111i e w
USED APPLIANCE <400,000 BTU
w:,,�.w:,,:::..r
.::..
AIR HANDLER <10,000 CFM
TAO
lt!
.O:T3
NOTE: MINIMUM PERMIT FEE IS $35.00
PP)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00=
-.
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x25.00 =
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
_$
SIGNATURE
Spokane County Division of Buildings