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1991, 04-18 Permit App: 91001921 Mechanical Fixtures
MECHANICAL PERMIT APPLICATION FORM Information Worksheet ' JOB STREET ADDRESS: G, /0/.007 t,,,,,, pt _ CITY/STATE/ZIP: •ilii PARCEL NUMBER: e" --5-.57c/ — OWNER: Tea T Cag-cc / PHONE NUMBER: MAILING ADDRESS: / %�i� / /. / ��-d (Street) CONTRACTOR: 1 o MAILING ADDRESS: (City/State) (Zip). LICENSE NUMBER: R.I PHONE NUMBER: (1%a - 733 ) DESCRIPTION (Street) G (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE q�ab� (Zip) NUMBER OF UNITS• X EACH • UNIT = AMOUNT ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) .WOODSTOVE/INSERT .::.::...:...:.....::...:...::.........:......:......::.... .GAS WATER HEATER GAS EQUIPMENT <100,000 I TU (INCLt DES/ GAS. EQUIPMENT +100,000. BTU DUCTWOR GAS PIPING (EA OUTLET) --BOILER/'RREFRIG 1-100M BTU .• BOILER/REFRIG 101-500M BTI BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG.1,0001•1 ,750M. B: BOILER/REFRIG +1,750M BTU_ HEATPUMP &AIR 'CONDITION ER 0 3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS :HEAT PUMP &AIRCONDITIONER 1530 TONS HEAT PUMP .& AIR CONDITIONER.30-50 TONS HEAT PUMP'& AIR CONDITIONER +50TONS: VENTILATING FANS EVAPORATIVE COOLERS: • TYPE I HOOD (PER 12' OR 12' PTN. -OF HOOD) TYPE.1,1 HOOD : ......................:.:......:........ CLOTHES DRYER RAN( • GAS LOG ;MISCELLANEO10.5i!(0017pow.R.mgOigww UNLISTED GAS APPLIANCE <400,000 BTU • ULINSTED GAS APPLIANCE>400,000BTU. USED APPLIANCE <400,000 BTU AIR HANDLER <10,000 CFM x 10,00. = x 25.00 x 10.00 = x12.00 x 1.5.00 . = x..1.00 = x 12.00 x 20:00 = x 25.00 = x 35.00 = x60.00.= x12.00 = x 20.00. _ x 25.00 x 35.00 x 6fl:00 x 10.00 x 10.00 x50.00 = x10.00 = x 10:00 = x10.00 = x 10.00 = x 10.00 x 50.00 = x100.00.= x 50.00 = x100.00 = x.12.00 x15.00 = 1. < NOTE: MINIMUM PERMIT FEE IS $35.00. SUBTOTAL $ � 3 Do PLUS: PROCESSING FEE +$ • 25.00 EQUALS: TOTAL PERMIT FEE DUE $ 3�•, v o SIGNATURE Spokane County Division of Buildings West 1303 Broadway. Avenue Spokane, WA 99260 (509) 456-3675