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1990, 05-31 Permit App: 90002401 ACs. MECHA;WCAL PERMIT APPLICATION FORM Information Worksheet f JOB STREET ADDRESS: CITY/STATE/ZIP: OWNER:, MAILING ADDRESS: ARCEL NUMBER: PHONE NUMBER: �? ---7 - --Z /,5 5L (Street) n (City/State) (Zip) CONTRACTOR: �� z c �`��C�, y� ij LICENSE NUMBER: �4.) PHONE NUMBER: ��.. MAILING ADDRESS: (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBERX EACH DESCRIPTION OF UNITS I UNIT = AMOUNT DUCTWORK SYSTEM_ WOODSTOVE/INSERT GAS WATER HEATER HEATING EQUIPMENT <100,000 BTU HEATING EQUIPMENT +100,000 BTU GAS PIPING (EA OUTLET) - _ _ _ _ _ _ _ _ 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 ONS _ 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' 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 x$10.00 _I x 25.00 - 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 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 $ PLUS: PROCESSING FEES+ $ 25.00 EQUALS: TOTAL PERMIT NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE _ $ O© SIGNATURE Spokane County Department of Building and Safety West 1303 Broadwav Avenue Spokane, WA 9260 (5 9) 456-3675