1992, 06-22 Permit App: 92004581 Mechanical FixturesV°•17 t MECHANICAL PERMIT APPLICATION FORM
ki kO � Information Worksheet
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JOB STREET ADDRESS: 3601 South Loretta Drive
CITY/STATE/ZIP: Spokane, WA
OWNER: Mike Mitchell
99206
MAILING ADDRESS: 3601 South
Loretta
PARCEL NUMBER:
(509) 928-2372 - HM
PHONE NUMBER: (509) 353-2504 - WK
Drive
(Street)
CONTRACTOR: Steinmetz
Heating & A/C
Spokane, WA 99206
(City/State) (Zip)
LICENSE NUMBER:
STEINHA142KF
PHONE NUMBER: (509) 922-2034
MAILING ADDRESS: 2114 North Pines Road, Suite 3 Spokane, WA 99206
(Street)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
DUCTWORK SYSTEM
WOODSTOE/INSERT
GAS WATER HEATER
HEATING -EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING,(EA.OUTLET)
REFRIG 1-100M BTU'4NOT A/C OR HEAT PUMP)
REFRIG 101-500MBTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750MBTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT -PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
EVAPORATIVE
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS _
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
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
1
1
2
= AMOUNT
x$?0.00 =
x 25.00 =
x 10.00 =
x12.00 =
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 =
10.00
12:00
2.00
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURENJYlikil-tA
SUBTOTAL
$ 24.00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $ 49.00
CK #4057
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675