1992, 01-28 Permit App: 92000487 Mechanical Fixtures'MECHANICAL PERMIT APPLICATION FORM
-,s.'Information Worksheet -:
'1
-,s.',
Information
'STREET ADDRESS :
F: CITY/STATE/ZIP: .'
t:
OWNER: C)e.,
MAILING ADDRESS:
(Street)
CONTRACTOR: -L`
PARCEL NUMBER: .
PHONE NUMBER: v ._ .'4 1 3
(City/State) (Zip)
LICENSE NUMBER: Ytt,g.0),.... )-(, OA z
PHONE NUMBER:
MAILING ADDRESS: Sr ( (o
' :(Street) (Cit
',MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
/State)
CA .,q- q et to co
(Zip)
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIING (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
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
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
1_
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 4.00 =
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 =
I gee
NOTE:
SIGNATURE
UM PERMIT FEE 5.00
Spokane County Department of
SUBTOTAL
$
PLUS: PROCESSING FEE
+'$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Building and Safety