1993, 05-21 Permit App: 93003818 ACMECHANICAL PERK IT APPLICATION FORM
Information Worksheet
•
JOB STREET ADDRESS:
CITY/STATE/ZIP: 1/45171
£, / 3i& /Ya Crf.
(�A 99A /(p PARCEL NUMBER:
OWNER: Pj(V) «'I d trcr
PHONE NUMBER: 9.-,Y
MAILING ADDRESS:
CONTRACTOR: A /00D
MAILING ADDRESS: e.
DESCRIPTION
(Street)
0_/7 -ir
.5/b3 ha.n/
(Street)
(City/State) (Zip)
LICENSE NUMBER: COCCC\Nl 17c'p ?,
PHONE NUMBER: Y - L(C/ 75 -
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSER7: i':, .
GAS WATER HEATER
'GAS EQUIPMENT:<100,000, BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
ieAS, P,IPING;(EA,OUTLE'T)..:::
BOILER/REFRIG 1-100M BTU
'BOILER/REFRIG 01 5OOM BTU 7
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG.1,0001 1,75.0M BTU:;
BOILER/REFRIG+1,750M BTU
,HEAT°PUMP'&;AIRj CONDITIONER'0-S TONS: `
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEATPUMP.&AIR CONDITIONERI5-30ETONS,-; T;:.
HEAT PUMP & AIR CONDITIONER 30-50 TONS
T
.HEAPUMP & AIR; CONDITIONER"+50 TONS',;
VENTILATING FANS
EVAPORATIVE COOLERS •;:i:::
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
;TYPE ILHOOD::>.;::'::.:::;;i:`:::::`::.....:,::..::.•
. ,:...:...:
CLOTHES DRYER
GAS LOG
•MISCELLANEOU&(NOTCOVERED ELSEYJHERE:;.:;::cs::
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED;GAS'APPLIANCE_>400,000
USED APPLIANCE <400,000 BTU
USED APPLIANCE .400,000 BTU
AIR HANDLER <10,000 CFM
AIR1HANDLER'>10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
West
(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 1.0.00 =
x sO.tbo =
xt00.00=
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/a (Th
SUBTOTAL
$ f,&_12j
+ $ 25.00
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
FEE DUE
LS7
_ $
Spokane County Division of Buildings
dway Avenue Spokane, WA 99260 (509) 456-3675