1992, 10-09 Permit App: 92008708 Mechanical Fixtures10,2n`6/Uo
MECHAt IICAL PERMIT APPLICATION FORM ? 5 (5
JOB STREET ADDRESS: /4773 / /
Am 99,z6 PARCEL NUMBER: l Y r`'
Information Worksheet
CITY/STATE/ZIP:
OWNER:
/91L/CA/91L/CA PHONE NUMBER: %.-71 7- 79 ?
MAILING ADDRESS:
(Street)
CONTRACTOR:
(city/State)
ALM QUALITY HEATING LICENSE NUMBER: AftopmlQiN,
E 1 fi 'firTW AN AvE.
SPOKANE; WA 99216
MAILING ADDRESS:
(Zir
PHONE NUMBER: j28-2100
(Street)
(City/State) (Zi;
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNLIT - AMOUNT
DESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-50014 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 >10,000 CFM
x$10.00 -
x 25.00 =
x 10.00 -
x 12.00. -
x 15.00 -
x„ 1.00.-
x 12.00,
x 20.00 s
x 25.00,M
x
5.00. -
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 -
,00
NOTE: MINIM M RMI��Tnn FE IS $35.00
SIGNATURE /(X ifi.-.9
SUBTOTAL
PLUS: PROCESSING FEE + $ 25.(
EQUALS: TOTAL PERMIT
FEE DUE = $ q,Q
Spokane County Department of Buildin�
land Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675