1994, 05-26 Permit App: 94004784 ACMECHANICAL PERMIT APPLICATION FORM 44 -4/1E9/
Information Worksheet
JOB STREET ADDRESS' N ) 411 g
2-J) Pd
CITY/STATE/ZIP;,5p.n/42- 0 p/,f/c( 79../0 PARCEL NUMBER:
OWNER: %Y) 4A& P . T1.�14 PHONE NUMBER: g,9 R - 5 79.,
MAILING ADDRESS:
(Street) (City/State) u (Zip)
CONTRACTOR: /\)c --rte, FJ-.P��l�-,°4� LICENSE NUMBER: /VP PC;/ HA 0-7 C 2
_ / PHONE NUMBER:
MAILING ADDRESS: J In 3 �i,.v,,.i- 5,p_, -L,„, _,Eva 993 /
(Street) (CIty/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WO.ODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT C106,000';BTU (INCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING (EA OU,TI:
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG lO1-$OOM:BTU:'
BOILER/REFRIG 501-1,000M BTU
.BOILER/REFRIG 1,0001-1,750M BTU :
BOILER/REFRIG +1,750M BTU
HEAT PUMP &'AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER_;15-30 TONS..•,
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP &AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS '
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II'HOOD
CLOTHES DRYER
'RANGE •
GAS LOG
.MISCELLANEOU$(NOT COVERED, ELSEWHERE-
UNLISTED
LSEWHERE
UNLISTED GAS APPLIANCE <400,000 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
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 =
x12.00 =
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 50.110 =
x100.00 =
x50.00 =
x100.00 =
x 12.00 =
x 15.00 =
I
/ LI, no
SUBTOTAL
$ /3.no
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$.37,00
SIGNATURE
Spokane County Division of Buildings
West 131 'way Avenue Spokane, WA 99260 (509) 456-3675