1992, 09-10 Permit App 92007463 Mechanical Fixturesq(o4 a , a.Oao
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: - / / a 04 ( -F✓i - t
CITY/STATE/ZIP: 'JO t<c.► Q ,LOA 9 G,PARCEL NUMBER:
OWNER: 50 V ()
MAILING ADDRESS: 05 c.i
(Street)
CONTRACTOR: LO t r +t'S H e U&, In *.
MAILING ADDRESS: ---R• O • 13 dK I I'-1(Ya,
(Street)
MECHANICAL WORK
DESCRIPTION
PHONE NUMBER: 50i - 35 e
(City/State)
LICENSE NUMBER: I.Pyr TNC
PHONE NUMBER: 55-G{:a7
a pON`b. rzQ , l OA
(City/State) - (Zip)
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVt=/INSERT
GAS WATER HEATER
GAS, EQUIPMENT,<100000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
'GAS PIPING (EA QU 1"LET) {:s•tri.>v .
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/l EFRIG 1,0001-1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT'PUMP & AIR CONDITIONER.0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
IHEAT;PUMP & AIR CONDITIONER ::15.4A0j1ONS411
HEAT PUMP & AIR CONDITIONER 30-50 TONS
;HEAT PUMP &•AIR CONDITIONER +50'T..(
.
VENTILATING FANS
...........................................................................................
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE IIH.. D 0 0
CLOTHES DRYER
; f :?}:{.w;.}i .:::•}}: ::::•:.}i}:6{i::L:iij:::::.:::::.::G: ii:.i:; ii i::? :>ii:::4i::f:::: ::::::
rvi }:;:}:{:},i::: i$:•^'t.i'F.:'riiiiiiT:::;:ij:^i:ii:^:::iii:: }i: j:i-0:tLl:;.:::::•:',
L�ANG Est irr.•.s:::.:::.,.,:.:�;:::::::•:r:;>a:;::
GAS LOG
`:MISCELLANEOUS (NOT COVEHED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
;ULINSTED'GAS APPLIANCE>400,000 BTU;;:. ....::
USED APPLIANCE <400,000 BTU
USED APPLIANCE>400000 BTU
AIR HANDLER <10,000 CFM
:'AIR HANOLt=R >10,000.,G�'M ;;,
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
IL)I c:,t-4
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 =
Jo. OO
/
/S. O O
20 .yC
44. O 0
/
/a_ Op
x 10.00 =
x 10.00 =
x 50.00 =
x 100.00 =
x 50.00 =
x100.00 =
/
/0 . 00
x 12.00 =
x 15.00 =
SUBTOTAL
$--/q,OO
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ ,
SIGNATURE c.
Spo ane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675