1994, 08-18 Permit App: 94008024 AC35262.1 ' MECHANICA PERMIT A PLICATION FORM
nk nation Worksheet
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JOB STREET ADDRESS:
CITY/STATE/ZIP,:��(i
OWNER: CY/n r, -c
MAILING ADDRESS:
qq-
�.Q J%/. PARCEL NUMBER:
-I
.
PHONE NUMBER: 5 ri - 739 Al
(Street)
CONTRACTOR:N,,- ,
MAILING ADDRESS:
(City/State) (Zip)
LICENSE NUMBER:MO /WO W/( 07
PHONE NUMBER:
c -
DESCRIPTION
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
:WOODSTOVP!(NSEHT>::<::'
GAS WATER HEATER
;GAS I=QUIPMENT100 000 BTU (INCLUDES::::`:
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS. PIPING: (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER(REFRIG;101500M°ETU
BOILER/REFRIG 501-1,000M BTU
BO! 0001:41;750M BTU'
BOILER/REFRIG +1,750M BTU
HEAT ':AIRCONDITIONER'0-3 TONS';:
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT,.PUMP & AIR CONDITIONER 15 30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT.PUMP & AIRCONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD ;`';;
CLOTHES DRYER
RANGE
GAS LOG
MISC.ELLANEOUS(NOTCOVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
,ULINSTED GAS. APPUANCE,>400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10000 CFM'
•
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00=
x 10.00 -
x 12.00 -
x 15.00 -
x1.00 =
x 12.00 =
x20.00 -
x 25.00 =
x35.00 -
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 50.1)0 =
X100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/
/.,. v 0
SUBTOTAL
$ 4).d>0
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $S7. OU
SIGNATURE t _
Spokane County Division of Buildings
West 131 'way Avenue Spokane, WA 99260 (509) 456-3675