1992, 10-09 Permit App: 92008698 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
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JOB STREET ADDRESS: /liP.-/' (?4,
CITY/STATE/ZIP: ., -'d_ , PARCEL. NUMBER: 654 • 266/
OWNER: 0 .,,e tA-C-7
PHONE NUMBER:
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MAILING ADDRESS:
(Street) (City/State) (Zip)
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CONTRACTOR: ri,�G'? �.'4'(2�1 � `��C 6 ICENSE NUMBER: G�/= �'� / �C��
PHONE NUMBER: , J�s . _ �--,9.53
MAILING ADDRESS: lr' (v,z_ r /:�et "rx1Z_ lG
(¢'pity/State) (Zip)
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UTNIT
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 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
AIR CONDITIONER 0-3 TONS _ _
AIR CONDITIONER 3-15 TONS _
AIR CONDITIONER 15-30 TONS
AIR CONDITIONER 30-50 TONS _
AIR CONDITIONER +50 TONS
FANS
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
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
= 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 12.00 =
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 =
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
Spokane County Department of Buildin and Safety
Wed 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675