1992, 10-06 Permit App: 92008402 Mechanical FixturesECHANICAL PERMIT APPLICATION FORM
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// II - 1rrfor:nation Worksheet
JOB STREET ADDRESS: J�1 • (D O(i (-Ce) (C)4(i0
CITY/STATE/ZIP: bi.."Ns / UJa_ Cq -2Ll 40 PARCEL NUMBER:
OWNER: AS r\ Fri az..- PHONE NUMBER: `)AC.(n - 3a'7
MAILING ADDRESS:
(Street)
(City/State) (Zip)
CONTRACTOR: E?- I r c tci Eid C k..11- Fe. LICENSE NUMBER: F-41C.O A1C. ! -73 b tom(
MAILING ADDRESS: t Ci 31 ..3iD )CALt (,
(Street)
DESCRIPTION
PHONE NUMBER: (-COO ciJ ---'`)
5 _ a e i.: � '19 2 (
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
1N000STOVE/INSE..
GAS WATER HEATER
GAS EQUIPMENT<100,000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTS E7
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEA1` PUMP R AIR CONDITIONER 0-3 ,.,,.�
HEAT PUMP & AIR CONDITIONER 3-15 TONS -
r'E T PUMP &:AIR GO.i'JDIT C NER 15 30_:7ONS:.
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONEP+50:T{
VENTILATING FANS
EVAPORATIVE:. COOL_.
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
II:
CLOTHESDRYER .::::............ _..-- ..--......----......:-------------...-..::..-:.-..
GAS LOG
MISCELLANEOUS (NOT COVFRPO'FLSE N=Rc
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
s;.
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= 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
x25.00=
x 35.00 =
x 60.00 =
x12.00 =-
x20.00 =
x25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x10.00=
x 50.00 =
x 10.00 =
x 10.00 =
J
) 0.00
a OD
- --
.
-..
x 10.00 =
--,
x 10.00 =
..1C.^e =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
6-00
SUBTOTAL
$ 0.2 -On
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
t �
= $ 44 7- w
Spokane County Division of Buildings