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1991, 10-25 Permit App: 91007189 Mechanical Fixtures
MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 50 tI CITY/STATE/ZIP: PARCEL NUMBER: OWNER: () I c (2(7_ Pn��%L ' PHONE NUMBER: MAILING ADDRESS: �g 8 SMITH HEd INth CONTRACTOR: E. 102 NORA MAILING ADDRESS: SPOKANE. WA 99207 (509) 328-4431 WAYNESH258NJ (City/State) LICENSE NUMBER: PHONE NUMBER: (Zip) DESCRIPTION (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVE/INSERT GAS WATER HEATER GAS EQUIPMENT <100,000 BTU (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. OF HOOD) 'TYPE II HOOD CLOTHES DRYER GAS LOG Mj$CEL1 I4Nl OUS (NO.TCOVERED £ISEYJHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED GAS APPLIANCE5400;000`91 USED•APPLIANCE<400,000 BTU USED ttra WC'E 400,000 BT J AIR HANDLER <10,000 CFM AIR HANDLER >10.000 C >` NOTE: MINIMUM PERMIT FEE IS $35.00 (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x10.00 = x 12.00 = x 15.00 =. x1.00 = x12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x25.00 = x35.00 a x60.00 = .., x10.00= x 10.00 = x 50.00 ._ /0 ai / -F)/ -D_ "3/ :. X10.00 = ," -x 1.0.00:=--- x10.00 x10:00='': x10.00 =: x 50.00 =' x100.00= . , x50.00 =c, x100.00 = x 12.00 = x15:00 =`- ...• .- - - SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ q9(1)/ SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675