1990, 03-16 Permit App: 90000903 ACJOB STREET ADDRESS:
CITY/STATE/ZIP:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
.5. 141J J B I tc. f'4 O/.
katix u Ci' rc2o4 PARCEL NUMBER:
OWNER: /ilex. AIbo
MAILING ADDRESS:
PHONE NUMBER: /7 1 g10O el
(Street)
CONTRACTOR: 01/2ihi t
MAILING ADDRESS:
//1 04 H1c qc;
(Street)
(City/State) (Zip)
LICENSE NUMBER: /9- //Le t)/-/ /y /( /-f
PHONE NUMBER: 1,2 it Do IS'
,-s o ki[ /Ze ala , qct - o Ca
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDU
NUMBER
DESCRIPTION OF UNITS
E
X EACH
UUNIT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
T
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU _
UNLISTED GAS APPLIANCE >400,000 BTU__
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
= AMOUNT
x$0.00 =
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 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
$ 47,00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 37.6o
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675