1992, 12-16 Permit App 92011041 Wtr HtrMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: �� % / ' C l/U' GU'SIr
CITY/STAZIP: S 45%/X /ARCELNUMBER:
OWNER:C- w - rr.G/� r"i'G-6- PHONE NUMBER:
MAILIN
ADDRESS: cr'r %c# G.6677 Y
(Streit)
CONTRACTOR:
oL(
9- 2 -
(City/State) (Zip)
LICENSE NUMBER:
/� PHONE NUMBER:
MAILING ADDRESS: //%-S C /. ' i/t' `/P'
(Street) i r (State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
>:I TO >
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
•
....::..::..::...:..::....:...:.....:.....::::....::.::
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
m a r :i.s.r:r.,Ya:tt�.. r ... Y ..5.�..w..�w.a.aw:lirl'wa.i:� wYyi:r• yyJ:; w Iii.M.11�Y� f.
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
i;�•t;14L'1.... . �7:•'.5a1:.1........V.. .. .. 4?4z:K7iE r?`2� i:.<............:..
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
•
__ _ _ - t.}:Y'r' i'fi•}:i}}:j::•}:": `}s f::i:i{•}: i'r: ri
CLOTHES DRYER
-:Mir
GAS LOG
......................... .
UNLISTED GAS APPLIANCE <400,000 BTU
n�►:::t:�>.err!�'�::,:::w:nn<:�th��ti::z�<rt::t>::;<:
USED APPLIANCE <400,000 BTU
:..
AIR HANDLER <10,000 CFM
:HAND:LE•00 CFi
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00=
x12.00 =
x 15.00 =
x1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x25.00 =
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 =
1
10
/2,
2
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ ('' ,U� �}
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675