1992, 11-06 Permit App: 92009820 Mechanical FixturesJOB STREET ADDR SS:
CITY/STATE/ZI
OWNER: 1 0/1 it
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
2 2
f� Z PARCEL (UMBER:
Op (2c PHONE NUMBER: J2,/ / 9,3
MAILING ADDRESS:
CONTRACTOR: f" 3 CO
(Street)
MAILING ADDRESS:
(Street)
DESCRIPTION
(City/State) (Zip)
LICENSE NUMBER: 74
" oaro 7f -761ePHONE NUMBER:�1��L/'Cl 975
i (r.(Y) ////'
City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVEIINSERT
GAS WATER HEATER
GAS, EQUIPMENT t;00 000:1 TU {INCL1DES <°
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA,OUT
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG101-500M; BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/RFR1G;:100011,7SOM ETU
BOILER/REFRIG +1,750M BTU
HEAT.PUMP 4. m9 CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT. PUMP&. AIR CONDITIONER: 15-30. TOUS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT::PUMP<& AIP CONDITIONER +50 TONS::';;'
VENTILATING FANS
EVAPORATIVECOOLERS'
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT: COVERED; ECSEWHEF
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE:>400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >409,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CPM >:
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 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 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 5610 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
--„,
/'/.
,,.
/ -, a
v-,,
7 (0
`J`
SUBTOTAL
$ ,�-). 0
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
/� a
= $ `�
SIGNATURE f��/
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675