1991, 07-25 Permit App: 91004503 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
L /dam. ry
PARCEL NUMBER: # /S`3'/ -
PHONE NUMBER: % Lv / .Jz-
9?2 i2
(Zip)
LICENSE NUMBER: ef}NNe'1F 378 11 7'
PHONE NUMBER:
J9 -STREET ADDRESS: 71/ S
ATE/ZIP: -Si" 9"J"f /E
OWNER: j'o A.l A 4-x7 n 0 Si
MAILING ADDRESS: "F10
(Street)
CONTRACTOR: C&fr?•-/nJ etc. P'`'lCto
6 - G a
MAILING ADDRESS:
'b 1300(.. 4434.fo
(Street)
City/State)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT <100,000 (#TU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 1101-500M:BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,00011,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP&'AIR CONDITIONER 0-3 TONS
FIEAT 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 FANS
EVAPORATIVE 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
ULINSTED 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
NOTE: MINIMUM PERMIT FEE IS $35.00
S!t,,'JATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
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 =
1
(2-'V0
• 1
1. o4
SUBTOTAL
$ / 3, a
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 3 r . 00
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675