1993, 04-16 Permit App: 93002595 ACMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS. -S, .A/Hr
'f ' Y a
CITY/STATE/ZIP: .9(C . L(t1 9go:y-7
OWNER: IS S G LQ) i c PHONE NUMBER: - 92
MAILING ADDRESS:
PARCEL NUMBER:
CONTRACTOR: 1Ut't
MAILING ADDRESS: E' . 5/Cj3 fii2-/
(Street)
DESCRIPTION
(Street)
(City/State) (Zip)
LICENSE NUMBER: (C Ei f l 701LC-
PHONE NUMBER:
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT <100,000' BTU (INCLUDES'
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001 1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP &`AIR CONDITIIONER 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 HOOK ` ...
CLOTHES DRYER
RANGE <>
GAS LOG
MISCELLANEOUS NOT::COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTER GAS APPLIANCE'>40,0000 BTU
USED APPLIANCE <400,000 BTU
.......................................................................................
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM;
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
West i J
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
X 10.00 =
x12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x12.00
x20.00 =
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 1,0.00 =
x 50.100 =
x100.00 =
x 50.00 =
x100.00
x 12.00 =
x 15.00 =
/V. d6
SUBTOTAL
$ /;, C
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
DUE
= $ 67)
.37FEE
Spokane County Division of Buildings
Broadway Avenue Sookane. WA 992fie (S(191 4SR-2F7F