1991, 02-15 Permit App: 91000560 Mechanical Fixtures 1
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: , /z J/Lc X. e ri 0b, Gc_. /)i'-
CITY/STATE/ZIP: _$Dc44 c /) e ; l,)& 7?;4/6 PARCEL NUMBER:
OWNER: 1Ir•li /''(hs (ec i--,?' e Lam i PHONE NUMBER:62(4) ,75-7- ;,Z/66
MAILING ADDRESS: LAP-,21/ Al I / 1,o etrl 4 CQ/ ///ci, 6€ Lila- 77 77
(Street) (City/State) /TL' (Zip)
CONTRACTOR:4----tie7 6-Fes'/? /j4EaZ ► crd7n JICENSE NUMBER: ,L�y/E1 ( C / (o(2-
,! PHONE NUMBER: .r?Ln - _67.57-3
MAILING ADDRESS: tr C'l>pz E 87a ,;z- 'City/State ) a (Zip) Z
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER / x 10.00 =
HEATING EQUIPMENT <100, 000 BTU / x 12.00 =
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (EA OUTLET) / x 1.00 =
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00 =
REFRIG 101-500M BTU x 20.00 =
REFRIG 501-1,000M BTU x 25.00 =
REFRIG 1, 001-1,750M BTU x 35.00 =
REFRIG +1,750M BTU x 60.00 =
HEAT PUMP & AIR CONDITIONER 0-3 TONS _ / x 12.00 = _
HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20.00 =
HEAT PUMP & AIR CONDITIONER 15-30 TONS _ x 25. 00 =
HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35.00 =
HEAT PUMP & AIR CONDITIONER +50 TONS _ x 60. 00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE COOLERS x 10.00 =
TYPE I HOOD (PER 12 ' OR 12 ' PTN. OF HOOD) x 50.00 =
TYPE II HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE x 10.00 =
GAS LOG / x 10.00 =
MISCELLANEOUS (NOT COVERED ELSEWHERE) x 10.00 =
UNLISTED GAS APPLIANCE <400, 000 BTU_ _ x 50. 00 =
UNLISTED GAS APPLIANCE >400, 000 BTU_ _ _ x100.00 =
USED APPLIANCE <400,000 BTU x 50. 00 =
USED APPLIANCE >400, 000 BTU x100. 00 =
AIR HANDLER <10, 000 CFM x 12 . 00 =
AIR HANDLER >10, 000 CFM x 15. 00 =
SUBTOTAL $
PLUS: PROCESSING FEE + $ 25 . 00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM/PSB I FEE IS $35.00 FEE DUE = $
SIGNATURE CCl- ;77t- Y
Spokane Coun v Department of Building_
Spokane, n and Safety
West 1303 Broadway
p venue WA 9260 (509) 456-3675