1992, 07-15 Permit App: 92005301 Mechanical Fixtures1
1
t�� W °c - �� MECHANICAL PERMIT APPLICATION FORM � � � 6
��� OCA '�D Information Worksheet 55c7
JOB STREET ADDRESS: b/,>, Com✓ {�-
CITY/STATE/ZIP%PARCEL NUMBER:
OWNER: -Of Ii . ��� PHONE NUMBER:
MAILING ADDRESS:
CONTRACTOR:
(Street)
(City/State) (Zip)
6c ge- LICENSE NUMBER: ///
PHONE NUMBER: ,?-005Z-545C
MAILING ADDRESS: // // T ,
(Street)
,4 r/9'�> //k
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER e x 10.00 =
HEATING EQUIPMENT <100,000 BTU / x 12.00 =
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4.00 =
GAS PINING (5 OR MORE. EACH:) v' x 1.00 =
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00 =
REFRIG 101-500M BTU x 20.00 =
REFRIG 501-1,000M BTU x 25.00 =
REFRIG 1,001-1,750M BTU x 35.00 =
REFRIG +1,750M BTU x 60.00 =
HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ x 12.00 =
HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20.00 =
HEAT PUMP & AIR CONDITIONER 15-30 TONS _ x 25.00 =
HEAT PUMP & AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP & AIR CONDITIONER +50 TONS _ _ x 60.00 =
VENTILATING FANS x"10.00 =
EVAPORATIVE COOLERS x,10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYPE II HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ x 10.00 =
UNLISTED GAS APPLIANCE <400,000 BTU_ _ x 50.00 =
UNLISTED GAS APPLIANCE >400,000 BTU _ x100.00 =
USED APPLIANCE <400,000 BTU x 50.00 =
USED APPLIANCE >400,000 BTU x100.00 =
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER >10,000 CFM x 15.00 =
= AMOUNT
•OD
i
-CC'
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NOTE: MINIMUM PERMIT FEE I8/$35.00
SIGNATURE
Spokane County Department of Building and Safety
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE •
_