1992, 12-07 Permit App: 92010713 Mechanical FixturesMt1:MAN8 ML rt$MN *YYUI A I WN runts
Information Worksheet QD-- -76
JOB STREET ADDRESS : ,5 $ ,P 7
CITY/STATE/ZIPt Pbi2' %' - W;;0 PARCEL NUMBER:
OWNER: Za2A/2 PHONE NUMBER: dd 39
MAILING ADDRESS:
(Street)
(City/State) (Zip)
CONTRACTOR:
+ - N s Nr�G Ail •- c. LICENSE NUMBER: j -m 1
PHONE NUMBER: q2 -L_- 'S� 0 v
MAILING ADDRESS: a. t\ 9 ers.1
(Street)
n \A/4". �•1" i4104'
(Ci y/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 PIPING (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 CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS _
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
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
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER X10,000 CFM
L2
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 4.00 =
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 =
x12.00
x 15.00 =
/0 6 ?
NOTE: MINIMUM PE IT PEE ;8 535.00
SIGNATURE
Sookane County Department of Meal and Sa%tY__
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE