1992, 04-09 Permit App: 92002345 Range, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: /7/1 c5 t' 6 2NC-
CITY/STATE/ZIP: SeO I"('%. JE 1 (- ric N PARCEL NUMBER:
OWNER: 1te(Pr,) N/&RsTH tI vArr2 PHONE NUMBER: 901A- 3t Y
MAILING ADDRESS: 1 II I,S- Com. (�✓1.v4ce ?tD/Owe 1 W✓as ht /
(Street) (City/State) (Zip)
CONTRACTOR: P&nipL'4uui. GO'S S6&/, UELICENSE NUMBER: P rt O GS /d-/ tf/t
PHONE NUMBER: S-3‘7- S 337
MAILING ADDRESS: C-. 6?-°? 820A-.Owrt-y 5P0I49-r.JGF 1 u.4t it S 9d -/L
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
`GASEQUIPMENT <100,000 BTU (INCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
•BOILER/REFRIG 101'-500M BTU
BOILER/REFRIG 501-1,000M BTU
,BOILER/REFRIG 1,0001-1,750M BTU,
BOILER/REFRIG +1,750M BTU
.HEAT PUMP&'AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP &'AIR-CONDITIONER:15-30 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)
?YPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT=COVERED ELSEWHERE ., •
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE>400,000.BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000BTU
'
AIR HANDLER <10,000 CFM
AIR HANDLER :1'.0';000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUN
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x1.00 =
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 =
x10.00 =
x 10.00 =
X10.00 =
X10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
Z
Z.Oo
/
/0.0o
/
/0. 00
SUBTOTAL
$ Aa.00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ y%o0
n County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
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