1993, 02-23 Permit App: 93001038 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
N
4 Info/rmationn Worksheet
JOB STREET ADDRESS: /+v 416 t7 l ..rc /t d
CITY/STATE/ZIP: int(ate? 9992/6 PARCEL NUMBER:
OWNER: ✓ti / a 44 PHONE NUMBER:
MAILING ADDRESS: /V mita q
1L4. -(('Z"
(Street) (City/State)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
�j f._/L
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT. ?;:t
GAS WATER HEATER
'GAS EQUIPMENT,< 00,00607:0 (INCLUDES;,'_.,'
GAS EQUIPMENT+100,000 BTU DUCTWORK)
:GAS PIPING.(EA:OUTLE7):'
BOILER/REFRIG 1-100M BTU
13OILER/REFRIG16I.500 9TU°'•a:'€r.:
BOILER/REFRIG 501-1,000M BTU
:BOILER]REFRIG;:1,0001-1,750M STU°::;
BOILER/REFRIG +1,750M BTU
HEAT PUMP. &:AIR_CONDITIONER 0-3ATONS;, ..
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT:PUMP, &,AIR GONDITIONER`1543Q TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT.PUMP;BCAIR.CONDITIONEI +50TONS'';:
VENTILATING FANS
;EVAPORATIVEiCOOLERS:4'>w
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
cTYPE II:HOOD:
CLOTHES DRYER
GAS LOG
MISCELLANEOUS; (NOT:COVER ED :ELSEWHERE::€:
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED; OAS APPLIANCE 5400;0® BTU:*'::' ":"'
USED APPLIANCE <400,000 BTU
USED APPLIANCE>400,000 ETU;;:"
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 =
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 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 =
12 .0-0
1,6U
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