1992, 11-06 Permit App 92009830 Wtr HtrCHANICAL PERMIT APPLICATIl,.4 FORM
Information Worksheet
JOB STREET ADDRESS: %S/ 3 SA),I)% / A) /)
CITY/STATE/ZIP: S e ; W t� 99,E I .2 PARCEL NUMBER:
OWNER: JCS 14 A) RJR E/19-ILL / PHONE NUMBER:
MAILING ADDRESS* -=.6/g' ‘P,
(Street) (City/State) (Zip)
CONTRACTOR:/ gFfiT/Ntr E 14/R LICENSE NUMBER: lU LOli E. P//C /bgJ'7
PHONE NUMBER:
MAILING ADDRESS•76' & X' /3 `'/9 $poi'/MN e_, tog.
(Street) . (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOQ0STOV:B/INSBRT
GAS WATER HEATER
GAS Q.UIPMBNT <100,000 BTU.(INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (FA OL.T
BOILER/REFRIG 1-100M BTU
FQILE /REFRIG 10.1 500M BTU
BOILER/REFRIG 501-1,000M BTU
.......... .
BOJLER/REFRI�G 1,0001 1,7 OM BTU
BOILER/REFRIG +1,750M BTU
HBAT PUMP & A►iA SONDITIONBR O 3 TANS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP :& AIR CONDITIONER 15 30.TQNS ;
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP &:AIR GONfITIONBR #50 TQN
VENTILATING FANS
VAPARATIV COOL RS
.............:..................................:
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE 11,HOOD....
CLOTHES DRYER
RANGE
GAS LOG.
„M;ISQE.L.!,ANKA)$INQI VBRED EI SEWHEF
UNLISTED GAS APPLIANCE <400,000 BTU
UI INSTED GAS:APP(IANCE:>400,000: TU
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000..CFM .:..:;
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATUREI .LLL %/ 1
99�/3
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x60.00 =
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 =
/
rd . 00
i
/, a D
x
x 15.00 =
SUBTOTAL
$ //OD
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ j6-60
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane_ .WA g92nn (Fncai aca_ge7c