1993, 02-08 Permit App 93000698 Htg EquipMECHANICAL PERMIT APPLICATION FORM
J r / Information Worksheet
JOB STREET ADDRESS: 1 ! q0(0 - 1_S/-
CITY/STATE/ZIP: L St70
OWNER: 47 Our, f'C
MAILING ADDRESS: IL1 /0 &O/ui ('2 -`
(Street)
CONTRACTOR: /1 /b 7/D V� 1;7
MAILING ADDRESS: P ; rj/6 j at/J/1-
(Street)
DESCRIPTION
PARCEL NUMBER:
PHONE NUMBER: 996, S .3C7
9z7a
(City/State) (Zip)
LICENSE NUMBER: A.)0/2 YJ (4 j9/ ?(")/Z.Z
PHONE NUMBER:
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WO D T V GAS WATER HEATER
GAS :EQUIP MENT <100,000 BTU .(INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING :(EA. OUTLET)
BOILER/REFRIG 1-100M BTU
BOlLER/REFRIG 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG1 0001.-1.750M BTU.
BOILER/REFRIG +1,750M BTU
HEAT.PUMP & AIP CONDITIONER 0 3;TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT.P,UMP..;&;:AIR.PONNTION01.iiq4apt0t
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT. PUMP &:A!R CONDITIONER +50;TONS!
VENTILATING FANS
EVAPORATI`JE'COOLERS
.,............::
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II:HOOD
....:..........:.....:>::;
CLOTHES DRYER
RANG:.:
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTEO GAS APPLIANCE 00 000'BTU
USED APPLIANCE <400,000 BTU
USEDAPPLIANCE >400,000. BTU
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000 CFM
NOTE: MINIMUM PERMIT FEE IS S35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x60.00 =
x 10.00 =
x,0.00 =
x 50.00 =
-�;
f ,a , ‹IL.
/,tr)
x 10.00 =
.
x 10.00 =
x 10.00 =
x 10.00 =
x 1,0.00 =
x 50.b0 =
x100.00 =
x 50.00 =
x100.00 =
x12.00 =
x 15.00 =
SUBTOTAL
$ / 5< 0Z
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 3Ya
t SIGNATURE_�� /�
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675