1995, 03-24 Permit App: 95001663 Mechanical FixturesJOB STREET ADDRESS:
CITY/STATE/ZIP: C
OWNER: �� r
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
s
�S-
PARCEL NUMBER:
PHONE NUMBER: Sa 3/3
MAILING ADDRESS:
CONTRACTOR: Jvr 0 -Y -co
(City/State) A J (Zip) /
LICENSE NUMBER: / �' Z', (O A Q 7 6 ' /
PHONE NUMBER:
MAILING ADDRESS: E 5/0 3 :,` y.s� / -
(Street)(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
..............................................
WOQDSTAVE/INSERr.... >
GAS WATER HEATER
GAS EQUIPMENT<fO0 0O0 U (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (ISA
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG
BOILER/REFRIG 501-1,000M BTU
...::::::...:.. ....
BQI.ER/REFRIG 1:,0001 1 750M BTU >> <> >:> ::
BOILER/REFRIG +1,750M BTU
HEAT 0410:pAomft CONDITIONER
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP &.All CONDITIONER 1:5-30:TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
......... .
HEAT PUMP & AI t CONDITIONER
VENTILATING FANS
r*�IAPORAIL.VE:.OOCyLER:S
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
i;Typielw
CLOTHES DRYER
GAS LOG
MISCEL.L.A IEOUS.(NOTCOVERED RLSEWHERI
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS' APPLIANCE 400,000
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
AIR .HANDLER >1:0,•
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x12.00 =
/
/j, pi
J
/07.00
x 15.00 =
X 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
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 5010 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
_
3 , () l-)
•
SUBTOTAL
$ ,,5, pa
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$50.00
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675