1991, 12-02 Permit App 91008283 Heating EquipMECHANICAL FERi i1T APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: / ) R 0 "
16
:_• t 4..!'•*, >
CLOTHES DRYER
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE`>40d0pp•BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10000,CFM
NO82e3 3SS)`
/C--e.6_4ef7
CITY/STATE/ZIP: v P�oZ64 PARCEL NUMBER:
OWNER:( fZ (/0/42 PHONE NUMBER:
MAILING ADDRESS:
CONTRACTOR:Ae
Atj (Street)
MAILING ADDRESS: r(pLJP-- LE /i(O>2�o')
(Street)
DESCRIPTION
PHONE NUMBER:
(City/State)
(City/State) //4� (Zip)
LICENSE NUMBER:T/�� �-/1/ J 1
9'9ao6,
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
•
GAS WATER HEATER
G 1S EQE IPMENT•: <: a}: ? }:}w> :x
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS A:0d x , •]v. vi{'••:CMM � .L.}_4s:f•
BOILER/REFRIG 1-100M BTU
_BO1 jA:SF :C 0I M ..
BOILER/REFRIG 501-1,000M BTU
jL.E EF rs Y . 'i Xlie1
-4.. , e::. xv:.•-vv'x}
BOILER/REFRIG +1,750M BTU
1t'1fiMjry "$tip" i:�/+7'y+�' �j•�� :..Y':.
:.-..-.::,w. w.-.. xw. �.v ~ i' :: i'•��!(Ud$ER .m .•:Cx••`:R:i++-S':f `$
:.:vr.•4'i.
. .rr...:.:+w✓x.,wr..v:..:.,vmv.: n,w1.,.,w: .:
HEAT PUMPv & AIR CONDITIONER 3-15 TONS
HEAT PUMP..:...,,..:x-.,.....::::«w-v:::.:;.:...�...:.:'�;
& AIR CONDITIONER 30-50 TONS
K-� `;`�#' � : `r�Sa=sY
...z.•.•:�.;;.�...:.::;.•-x.:.�.
VENTILATING FANS
.-.ti;.:::;;a-,;,`,.:.:.:::::::.:_:::::t.>�.�::r:+-'�•�t••c- ,:s:$;:;: e;: o:};.a;�rr.>u;-?::;
TYPE 1 H
OOD (PER 12' OR 12' PTN. OF HOOD)
sue` �:..__....,� _.. ..............: .4 >:-w.q.} •v,,�^-- -ii{L$ -;°:> ::Yc�':". - „GY:..
NUMBER
OF UNITS
X EACH
UNIT
•
•
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 =
= AMOUNT
NOTE: MINIMUM PERMI FE IS $35.00
SIGNATURE
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