1992, 10-06 Permit App: 92008450 MechanicalMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:_ S /Uv5` iou''4":_ )?w
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CITY;STATE/ZIP:'" X�Xa, Gsl,�, PARCEL NUMBER: 593, 0%O(p
OWNER: 14A PHONE NUMBER
MAILING ADDRESS:
SMITHQ (City/State) (Zip)
CONTRACTOR: E. 102 NO` A LICENSE NUMBER:
(509)328-4431 PHONE NUMBER:
MAILING ADDRESS: WAYNESH25"
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING `(EA OUTLET):
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 10.1:-500M BTU
BOILER/REFRIG 501-1,000M BTU
BOI LER/REFR IG:1,000.1=1,750M BTU.
BOILER/REFRIG +1,750M BTU
HEAf.00MP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONOITIONEW15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMPA AIR.CONDITIONER +50 TONS
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 <400000 BTU
ULINSTED .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
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 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/
y
t ,
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $ 'y-e/vv
.. Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675