1992, 09-10 Permit App: 92007460 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM (�
Information Worksheet
JOB STREET ADDRESS: .`5 Yi
CITY/STATE/ZIP: X11 PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Zip)
(Street) (City/State)
CONTRACTOR:- = LICENSE NUMBER:
X PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
:GAS EQUIPMENT •<:100,000 BTU (INCLUDE=S'
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
:BOILER/ . EFIIG T 000 750M B
........................
..............
.....................................................................................................................................
BOILER/REFRIG +1,750M BTU
:HEAT PUMP & AIR C 1NDITION R 0•
HEAT PUMP & AIR CONDITIONER 3-15 TONS
..................... .
HEAT PUMP & AIR' CONDITIONER 15 30 TONS :>: .
HEAT PUMP & AIR CONDITIONER 30-50 TONS
;HEAT PUMP & AIR>CONDITION
VENTILATING FANS
........................................... . .
EVAP
RA IVE L
T O E
O
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
.........................::.
CLOTHES DRYER
AN
.R
>R:
N
..................................................................................................
GAS LOG
_;MISCELLANEOUS (NPT' COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
;.ULINSTED GAS APPLIANC•E•>400,000 BTU....i
USED APPLIANCE <400,000 BTU
USED... APPLI
AN E *w
AIR HANDLER <10,000 CFM
AI.
HANn:
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00
x 10.00 =
x12.00 =
x 15.00 =
x1.00 =
x12.00 =
x20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x25.00 =
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 =
x10.00=
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
-
)
iU . CD
lc' 0-L)
SUBTOTAL
$ 1_).0-0
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 1-(5.61)
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675