1990, 01-02 Permit App: 90000004 Mechanical FixturesMECHANICAL PERM! ,APPLICATION FORM
Information Worksheet
JOB - STREET ADDRESS: HOW OW 5. N/1 i t i A vK J 4�
CITY/STATE/ZIP: (A- PARCEL NUMBER:S /�.P -✓
OWNER: U/A1 cat_ 21 w1 e 44 IM
0.1
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
t NUMBER- X EACH
OF UNITS UNIT
DESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT_
GAS WATER HEATER _
HEATING
_ _....
HEATING EQUIPMENT!<100,000'BTU _
HEATING EQUIPMENT +100,000.BTU r
GAS PIPING (EA OUTLET)_ _ _ _
REFRIG 1-100M BTU (NOT A/C OR HEATPUMP)
REFRIG 101-500M BTU_
REFRIG 501-1,000M BTU - - - - - REFRIG 1,001-1,750M BTU_
REFRIG +1,750M BTU _ _ _
HEAT PUMP & AIR CONDITION- ER 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 FANS
EVAPORATIVE COOLERS!_NOM 000 .01M.
- -_ _ -
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)`
TYPE TT,Hoop_
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 s _
AIR HANDLER >10,000 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 =Q
x 50.00
x, .0.00
x10.00
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
SIGNATUREC7i?¢..
Spokane County. Department of Buildin and Safety
West 1303 Broadwav Avenue Spokane, WA 99260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE
$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ y9,.