1993, 01-28 Permit App: 93000470 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: ' 9//
CITY/STATE/Zip: �p. r to
OWNER: ,t&ni _ & t % a /---e64-1
MAILING ADDRESS: 47/ 1
(Street)
LA-5-uTo
PARCEL NUMBER:
PHONE NUMBER: `9 /y
2 VOC9 r
!J-�fJA Ul er 9;6 6
(City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
:WOODSTQVEIINSERT
GAS WATER HEATER
GASEQUIPMENT <100,000:BTU (INCLUDES,
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS; J.PJNG_.(EAOU 's:1 -y r.:.,
BOILER/REFRIG 1-100M BTU
,BOILER/REPRIG_l01-500M°BTU
:::rS
BOILER/REFRIG 501-1,000M BTU
•BOILER
:../pEFRIG1 X0001-1 °,750M .67U.[°''::;
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 04:T,ONS;.
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT:PUMP.&AIR CONDITIONER 15:-30'TONS_
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEATPUMP &AIR CONDITIONI R +50..TONS'.::::
VENTILATING FANS
EVAPORATIVE. COOLERS.::'
.................:.:.:..........
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE'dU_HOOb
CLOTHES DRYER
GAS LOG
MISCELLANEOUS (NOTCOVERED?ELSEWHERE ":::
UNLISTED GAS APPLIANCE <400,000 BTU
.ULINSTED:GAS APPLIANCE:>400000, BTU.:
USED APPLIANCE <400,000 BTU
USED' APPLIANCE.>400,000:BTU::: s [::.:;'
AIR HANDLER <10,000 CFM
AIi3.HANDLER')10,000
NOTE:, MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
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 =
/x,00
/, rte)
SUBTOTAL
$ f3.00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
��
= $ °i Z�
3,(D
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675