1991, 01-02 Permit App: 91000005 Mechanical FixturesJOB STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
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CITY/STATE/ZIP: to&leati� � /0,zi l qr PARCEL NUMBER: /7-2-e4„/G�2 �
PHONE NUMBER: 9
OWNER: lf.C, i)R.J Ait
MAILING ADD ESS :
CONTRACTOR:
(Street)
QGILA ,QI b49 -,v
MAILING ADDRESS: /9( a % 0 7
(Street)
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"(City/State) (Zip)
LICENSE NUMBER: S /4R - 37x/11
PHONE NUMBER: 9ss9- / /7 C% X
,e.>79 92zn
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
= 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
REFRIG 101-500M BTU
HEAT PUMP)
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
r
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 _
x-_
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 =
/0.(9b
.DU
00
NOTE: MINIM SM: E ` IT FEE IS $35.00
SIGNATURE C�� 0/1,0„(4,
Spoka e C s ty Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ (--/g�