1990, 10-16 Permit App: 90005413 Mechanical FixturesOX, "�-vv
MECHANICAL PERMIT APPLICATION FORM /)277
Information Worksheet
JOB STREET ADDRESS: /C0 / _ t '/,r, e a 7_55•/ - /f/d -
-�f
ti - /e
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS: f1•1-
(Street)
`1
(Street) (City/State) (Zip)
CONTRACTOR: /ice t 0 f_.-..- jai c LICENSE NUMBER: PI / 4'/ JP
PHONE NUMBER: Ver -2 -?33-3
MAILING ADDRESS: n "- i ii/Y., L" 7.1 v^ : c_/ ° /4:
(Street)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER. _ HEATER . _ _ _
HEATING EQUIPMENT <100,000
HEATING EQUIPMENT +100,000
GAS PIPING , (EA..:OUTLET)
REFRIG'1-100M BTU (NOT A/C
REFRIG .,,1O1 -500M BTU ' •
REFRIG5.O,1,-1., 000M_
REFRIG01-1,750M:;BTU
REFRIG.:+1,750M BTU r_ _ _
HEAT Y PUMP"AIR CONDITIONER ` 0-3 a: TONS
HEAT'; PUMP,' & ;.FAIR_. CONDITIONER`: 3-15zfTONS
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'
TYPE II HOOD
CLOTHES DRYER
RANGE
BTU,.
BTU 7 - -
OR HEAT: PUMP
GAS LOG
OR 12' PTN. OF HOOD)
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU_
UNLISTED GAS APPLIANCE >400,000 BTU -
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
X,°
X11
xf22
x
xy�
ti,.
x'�35r:00:�
x 60:00°._
x.10.00 `
x 10.00,.=
x 50.00;=
x 10.00
x10.00 =
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 =
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
$ /3
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675