1991, 08-23 Permit App: 91005280 Mechanical FixturesJOB STREET ADDRESS:
CITY/STAT E/Z) P:
OWNER:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
PARCEL NUMBER:
4 PHONE NUMBER:
MAILING ADDRESS: (C_ ` -e S�ol�c �-- liJ`�` Z ,e
(City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
W D
00 STOVE/INSERT>>
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTIJ
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING(EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/1 EEffUG.1,0001-1,750M
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
................................
HEATPUMP& AIR CONDITIONER +50 TONS
.VENTILATING FANS
............ .
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
ULINSTED 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
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x50.00 =
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 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675