1992, 01-15 Permit App: 92000262 Mechanical Fixturesa7 i
11 MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP:
OWNER: �s
MAILING ADDRESS:
E ry 12 0 }'Yt,L
A `1
(72.-1( PARCEL NUMBER:
PHONE NUMBER: 2_ - S-7 3 3
(Street)
CONTRACTOR:
(City/State)
(Zip)
LICENSE NUMBER: A- ' 2r 1 I W
PHONE NUMBER: `'Ig` 7- y 12- r
MAILING ADDRESS: '` , \V -J 'F, .&
(Street)
Lk.)
`-?I 2v 7
ty/State)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
N'L r BER X EACH
DESCRIPTION OF UNITS ITNIT •
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 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M.BTU
REFRIG +1,750M BTU
HEAT PUMP. '&'AIR CONDITIONER 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
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
C OTNES 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
= 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 0C
x720.00
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 =
\2 c c)
\2. C0
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE (1),,.44,J,
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE
25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ `i 9.0 0