1990, 01-10 Permit App: 90000132 Mechanical FxituresMECHANI I T,APPLICADON FORM
Information Worksheet
JOB STREET ADDRESS: S_ to Oa Lo r� 4�
Via . ?Mt, 'PARCEL NUMBER:
CITY/STATE/ZIP:
OWNER: {S1 nA H(14rJA PHONE NUMBER:'9c 7- oO ,
MAILING ADDRESS: j. (p(:)49,_ L -Greif q ` Cj oka rf) WA- . 5102.0
(Street) (City/State) (Zip)
CONTRACTOR:
LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street)
MECHANIC
DESCRIPTION
(City/State)
ORKSHEET/FEE SCHEDULE,
NUMBER X EACH
OF UNITS UNIT
DUCTWORK SYSTEM _
WOODSTOVE/INSERT
GAS WATER HEATER_ _ _
HEATING EQUIPMENT -<1.65,-60-6 BTU
HEATING EQUIPMENT +100,000 BTU _-
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU _ (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU,_
REFRIG 1,001-1,750,( BTU.
REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS _
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING PANS -
EVAPORATIVE COOLERS _ _
TYPE I HOOD (PER 127 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 >10000 CFM - - - - - - -
(Zip)
= 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
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PROCESSING
EQUALS: TOTAL PERMIT
FEE DUE
okane County Department of Buildinq and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (5 9) 456-3675