1990, 04-30 Permit App: 90001758 Mechanical FixturesMECHANIC!L'F'tRMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: / /49n/n %Boone
CITY/STATE/ZIP: spa ue t�/LI. Y`�j?/‘ PARCEL NUMBER:
OWNER: 4.4
MAILING ADDRESS: Sz,zc__
PHONE. NUMBER: %2c -aaJ3"
D • (Street)
CONTRACTOR: 4 f ta-/(moo ,
(City/State) (Zip)
LICENSE NUMBER: aE 7-S 0 C.2 7/ 6/G
PHONE -NUMBER: sk- 51?C=••.yycy
MAILING ADDRESS: )3 3?tZ) /74/ce.s / �
(Street) -
City/State)., ,,(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU:2..5 o
HEATING EQUIPMENT +100,000 BTU .`••-
GAS ,PIPING (EA OUTLET)
REFRIG 1-100M,BTU (NOT A/C ORHEAT PUMPYc
REFRIG 101-500M BTU-..
REFRIG.501-1,000M BTU-
REFRIG 1,001 -1,750M -:BTU
REFRIG +1,750M BTU
HEAT PUMP & ATR CONDITIONER 0-3 TONS', -4
HEAT PUMP & AIR CONDITIONER 3 -15 -TONS; .
HEAT PUMP & AIR CONDITIONER 15-30 TONS;?"
HEAT PUMP.& AIR CONDITIONER 30-50 TONS.,t';'
HEAT PUMP & AIR CONDITIONER +50 TONS., -
VENTILATING FANS
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
4
= AMOUNT
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
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 =
x10.00 =
x 50.00 =
x,10.00 =
x;10.00 =
X-16:00
x 10.00.=
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/'fie-oo
o v
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
NOTE: MINIMUM ERM/NIIT FEE IS $35.00
SIGNATURE ///�. ���j
r /
Spokane County Department of Building and Safe
West 1303 Broadway Avenue Spokane, WA 99260 (5
EQUALS: TOTAL PERMIT
FEE DUE
00
9).456-3675