1993, 01-11 Permit App 93000137 Gas LogMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 4.,-
CITY/STATE/ZIP: - PARCEL NUMBER:
PHONE NUMBER:
OWNER:
MAILING ADDRESS:
(Street) (City/State)
(Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
(ii " D l.A.Jr C
MAILING ADDRESS: 01)-3 /..-- i -...-
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
- itr
GAS WATER HEATER
e eeeeeeeee.weee)....ee
GAS EQUIPMENT +100,000 BTU DUCTWORK)
. .
BOILER/REFRIG 1-100M BTU
•')" ••,,,:::,),•••:•••)))):::•••:••••••)•)•••),••••••:•):••))))):•••:,
, „ ... 7.101 P. ",„ ''' ....... •
BOILER/ REFFilG 501-1,000M BTU
1
1301tER/REFRIG +1,750M BTU
HEAT PUMP AIR CONDITIONER 3-15 TONS
• •
HEAT PUMP & AIR CONDITIONER 30-50 TONS
.•
VENTILATING FANIS
• •••••V•:;),),,,Y,
. .r.....,••••••XxWAVX• •••
TYPE I 1-006-(PER-12' OR 12' PTN. OF HOOD)
..„ „
CLOTHES DRYER
•••
) ••• • •-•.• •
••••••••• :A:4f •
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
USED APPLIANCE <400,000 BTU
•••••• ,
•
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
0 C••• 0,
I 1
(Zip)
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 =
x 10.00 =
x 10.00 =
x 50.00 =
4
--t-5
I
1 at-D
I
,
•
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ ' 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 7terit--%
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
PLUMBING PERMIT APPLICATION FORM
Information Worksheei
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
(Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
TOILETS
:::.::::.:...:..::.........
SHOWERS
KITCHEN SINKS
DISH W:ASF $
GARBAGE DISPOSAL
UTILITY SINKS
FLOOR DRAINS
;FLOOR:SINKS
.::..::.:..:... .:..:.......:..:..
BAR SINKS
LAWN SPRINKLER — FOR EACH BACKFLOW DEVICE
WATER SOFTENER
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x6.00 =
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 =
x6.00 =
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