1993, 04-30 Permit App 93003079 VOIDCONTRACTOR:
MECHANICAL PERMIT APPLICATION FORM
Information/Worksgeet
7,7
3- Zt JOB STREET ADDRESS: 66 E.A/Ve(-5I
CITY/STATPJZIP• SNckoiA,° 1 1 i A G 26 19(, PARCEL NUMBER:
-% n
OWNER: ( inerr4/e1 a/ale PHONE NUMBER: 8'I / -6 7 /
MAILING ADDRESS: 5• Z206 i42 e(51
t9ze,4
(Street) (City/State) Pp)
LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Zip)
(Street) . (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
�sr e» ��nr.Wrvn�s�e
b..f*^y�IyIS�
GAS EQUIPMENT+100,000 BTU DUCTWORK)
M#,.
tigiala
BOILER/REFRIG 1-100M BTU
ragragott
BOILER/REFRIG 501-1,000M
BOILER/REFRIG +1,750M BTU
HWW1015
�.
• HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
TYPE 1 HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
TM SC
UNLISTED GAS APPLIANCE <400,000 BTU
LEM
USED APPLIANCE <400,000
_;,:; , .»,�<,;:,�sM:,=:� mow.,.
AIR HANDLER <10,000 CFM
3At..RlklANtu.Ft ::, ;. G DOA;it
NOTE:. MINIMUM PERMIT FEE IS $35.
SIGNATUR
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 =
x20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x50.00 =
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
= $
Spokane County Division of Buildings