1993, 02-22 Permit App: 93000995 Mechanical Fixtures45ILI ,21/20i 6-1'
I MECHANICAL PERMIT APPLICATION FORM
vt/'O4c4( 'I u tJ�7 S ��f
/ ) // / /� Information Worksheet
JOB STREET ADDRESS: / l Fi . &OM
CITY/STATE/ IP:
OWNER: Oh
(.0P cgZ./lp
-Yl.4,Ltinnt\
3197
PARCEL NUMBER:
PHONE NUMBER: %c9 7- 75 36/
MAILING AD RESS:
CONTRACTOR: 130fi ( )
MAILING ADDRESS: E.
DESCRIPTION
(Street)
( 011
?5/ (v3%n n rc-f
(Street)
(City/State) (Zip)
LICENSE NUMBER: A!(?!CON/#/70( Z-}
PHONE NUMBER: , `? � '-(-f 97S -
LA -1 99e")/a
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
................................................................
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT<100,000BTU (INCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
;BOILER/REFRIG 101-500MBTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001-1,750M BTU'.
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR: CONDITIONER 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 & AIR: CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN
TYPE II HOOD
CLOTHES DRYER
RANGE_ 4
GAS LOG
MISCELLANEOUS(NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE>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 =
x 25.00 =
x 10.00 =
v
/Z),
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
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 =
/,t_(T2)
�1�,
cpi
$ (9y dY
SUBTOTAL
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
/�
_ $ 1
SIGNATURE__
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675