1993, 06-01 Permit App: 93004126 Mechanical Fixtures50"t5` 0( IS MECHANICAL PERMIT APPLICATION FORM
v Ua 5 33F3 Information Worksheet
JOB STREET ADDRESS: aoa 4/ N. "® 64.6.4241-
CITY/STATE/ZIP:
'.z a-7`'CITY/STATE/ZIP: O,&loc ., /[,c"i qua PARCEL NUMBER:
qe
OWNER:SZfU444/ 9?
MAILING ADDRESS: c› -O n -e-,
PHONE NUMBER:: 901 ./-09/7
(Street) ' (City/State) '(Zip)
CONTRACTOR: p,q-12-n S _ t -,,,LICENSE NUMBER: A -yLm it.r .l lC it Z
PHONE NUMBER: .C1417 - SUv v
i11041 • Eouo Pr-jcl.
MAILING ADDRESS: ' W.\,,L9 (l. V...4.. -los .�' a, _..',(nom 442.1 L
(Street) • (Cit /State) • (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER . -X/EACH
OF UNITS UNIT
DESCRIPTION
=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 &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDIT-IONER 0-3 TONS.
AIR CONDITIONER 3-15 TONS
AIR CONDITIONER 15-30 TONS
AIR CONDITIONER 30-50 TONS
AIR CONDITIONER*+50 TONS
FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12''OR12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS DOG
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 1540 =
is 4.00 =
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.=
/0.66
4.7.00
�.00
NOTE: MINIMUM PERMIT .FEE I8 $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL ERMIT
FEE DUE,
'Spokane County Department of :,Building and .Safe
West 1303 Broadway Avenue 'Spokane, WA 99260 (5
5191, 00
9)'456-3675