1993, 03-11 Permit App: 93001401 Mechanical FixturesS B' M CHANICAL PERMIT APPLICATION FORM
PiI IInformation Worksheet"l Q
JOB STREET ADDRESS: 001 S• en, t,,, a c sk. �
CITY/STATE/ZIP: SrtS A & Loa_ 90 ito(o PARCEL NUMBER:
OWNER: flrr.. ISZ$C,ln ayry
k).s PHONE NUMBER: 92y -[)SI O
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: rI1ICC, G!ai?Or-.id Cif hifFa LICENSE NUMBER: k4IC.0C-/%.l 773bLl
PHONE NUMBER: (Sc C.aL• -,' % I 1
MAILING ADDRESS: F • /I -3I D _7.)DrEn0ji.l'
(Street)
DESCRIPTION
(City/State)
-r- MECHANICAL WORKCHEET/FEE SCHEDULE,
•ELECTRIC/DUCTWORK (SEPARATE. SYSTEMS
WOODSTOVE/INS RT
GAS WATER HEATER
;GAS EQUIPMENT<'1.00,000 BTU ONCLUD S
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS P!ElNG (�1 OUT.LET)
BOILER/REFRIG 1-100M BTU
301LE R/RE -RIG i01; 500M BTU
BOILER/REFRIG 501-1,000M BTU
oQILE.W EFRIG :g9. 1 1,Zo0M B i U
BOIL R/REFRIG +1,750M BTU -- ----
HEA PUMP;& AIR'. CONDITIONER 0-3; T.O.NS
HEAT PUMP & AIR CONO'TIONER 3-15 TONS....
HEAT PUMPI& AIR CONDITIONER 15 30 -TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS --
NEATPUMP:&AIR:CONDITIONEP,+50TONS .
EVAPORATIVE. COOLERS:
TYPE I HOOD (PER 12' OR 12' PTN
1:P. II _HOOD
CLOTHES DRYER
GAS LOG
,
MISC _LLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GASAPPLIANCE>400;000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE>:00 000:BTU
AIR HANDLER <10,000 CFM
AIR HANDER •10 000. CFM
OF HOOD)
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER V ' -
OF UNITS
X EACH
UNIT
= AMOUNT
x10.0u =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x20.00 =-
x 25.00 =
x 35.00 =
x60.00 =
x 12.00 =-
x 20.00
x25.00 =
x35.00=
x 60.00 =
x 10.00 =
x10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x10.00=
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
.. .
1
1 , OD
I
IrD,Ou
_
SUBTOTAL
$ ft -Oh
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
I
= S 2 2 l. o-
SIGNATURE
Spokane County Division of Buildings