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1991, 08-28 Permit App: 91005403 Mechanical Fixtures
MECHANICAL PERMIT APP3ICATION FORM Information Worksheet JOB STREET ADDRESS: CITY/STATE/ZIP: ). ' -111' f � - (? �w6PARCEL NUMBER: r PHONE NUMBER: �% �� yr�_3, OWNER MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: _('_=:� �(� !� k ,, �1 LICENSE NUMBER: �C_ 372/�.' / PHONE NUMBER: -Y MAILING ADDRESS: C')(i�`s .� / r / t.� ,�' 'r`."� c l' (Street) (ICCity/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION I NUMBER -OF UNITS ( X EACH UNIT = 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 HEAT PUMP) REFRIG 101-500M BTU_ _ _ _ _ _ _ _ _ _ _ REFRIG 501-1,000M BTU_ _ _ _ - _ _ - _ _ REFRIG 1,001-1,750M BTU- _ _ - - - - - - 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 +50 TONS _ _ VENTILATING FANS _ _ _ _ _ _ _ _ _ _ _ _ EVAPORATIVE COOLERS _ _ _ _ _ _ _ TYPE I HOOD (PER 12'_ OR 12' PSN. 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 _ _ _ - _ _ - - x$10.00 = x 25.00 = x 10.00 = x 12.00 = x 1�- _ x -6 @- 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 = / SUBTOTAL $ i,Q PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT t>U NOTE: -SMI IMIIXFEE IS 35.00 FEE DUE _ $ SIGNATURE�_�%h Spokane Cou, Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675