1990, 08-28 Permit App: 90004229 Mechanical FixturesJOB STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM
Information Wor sheet
//7
CITY/STATE/ZIP---5/45% t'CF
OWNER.
4e/i /
Me /?//
MAILING ADDRESS:
(Street)//
CONTRACTOR: f1/1)(/ % C
MAILING ADDRESS:
(Street)
PARCEL NUMBER:
P ONE NUMBER:
(City/State)/104J If
Jj(Zip)
LICENSE NUMBER. /�-(5 N ES 0_7(----/vo
v
PHON BER:
C 77
4�Awa 77 'i.
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE.
-
X EACH
UNIT
DESCRIPTION
NUMBER
OF UNITS
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING.EQUIPMENT"+100,000 BTU
GAS PIPING•(EA'OUTLET)
REFRIG 1-100M.BTU (NOT A/C OR HEAT PUMP)
REFRIG101-500M,:BTU
REFRIG 501-1,000M BTU
REFRIG :1,001 -1,750M -BTU_
REFRIG +1,750M BTU:':,'; 4 ::
HEAT:: PUMP & AIR;;_ CONDITIONER'• 0.3 TONS: ',:_
- HEATPUMP, ";'&'.`- AIR<. CONDITIONER ' 32.15 ' -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)
CLOTHES DRYER
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
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
= 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
x 25.00.=
x-35.400 =
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 =
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA -92260 (5.09) 456-3675_