1991, 08-05 Permit App: 91004697 ACMECHANICAL PERMIT APPLICATION FORM
Irformation Worksheet
JOB STREET ADDRESS: /:3(4;0, /0)24. Yno5
CITY/STATE/ZIP: 4 wow, yi.e, W4 %D)(„ PARCEL NUMBER:
OWNER: >Sit ) (20L, PHONE NUMBER:-/ ? • -7 ( 79
MAILING ADDRESS: nq l a L Ika-f d[iaa-,4 0 MA 93-I6
(Street) ,(City/State) (Zip)
CONTRACTOR:XikAA &_ / LICENSE NUMBER: S'8 - P(2 -S E ".3-7 Aul-
PHONE NUMBER: c/ 9-,/ 7()
MAILING ADDRESS: ()N3 T5-70-7
(Street) (City/State) (Zip)
MINT ailZ1111flallIW
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH.
OF UNITS UNIT
DESCRIPTION
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT.
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 4 OUTLETS)
GAS PIRING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER 0-3 TONS
AIR CONDITIONER 3-15 TONS
AIR CONDITIONER 15-30 TONS
AIR CONDITIONER 30-50 TONS
AIR CONDITIONER +50 TONS
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
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$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 29.29
x -4.-7-19-0--
x
90--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 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
X 15.00 =
.o6
10SIGNAT
NM FEE IS 3 .00
bat,"
Q
Spoka e Co W Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
$ la L
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE