1993, 06-22 Permit App: 93004938 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: , 3 2Q, i nc3 d; S t,
CITY/STATE/ZIP: 5Q o Y) ' _ (DG.
OWNER: � U E
O ie
MAILING ADDRESS: jam
PARCEL NUMBER:
PHONE NUMBER: 722- 30/1"
" n(Street) (City/State) (Zip)
/
CONTRACTOR: /04 k'ha / `h, 0jQ( co L LICENSE NUMBER: A AT -1n CS /0O/Col
o PHONE NUMBER:
MAILING ADDRESS: _ , % p /(p 6Uo Qc/4jo � S7,t/cc ne &)ot ??2-12
(Street) (City/State) • (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENTEI100,000 BTU (INCLUDES
GAS EQUIPMENT +100 000 BTU DUCTWORK)
GAS PIPING (EA OUTLET) s
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M f3TU
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 & MR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50TONS
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
ULINSTED''GAS APPLIANCE>400,000'BTU :'.
USED APPLIANCE <400,000 BTU
USED APPLIANCE>400 OOO:iBTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE �
kane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =-
x
x 35.00 =
x60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x50.00 =
x 10.00 =
x 10.00 =
x10.00 =
x 10.00 =
x 10.00 =
x50.00 =
x100.00 =
x 50.00 =.>
x100.00 =
x 12.00 =
x 15.00 =
/
f
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
�/
= $ iO