1990, 06-21 Permit App: 90002880 ACMECHANICAL PERMIT PPPUICATION FORM
Info tin/ Worksheet
JOB STREET ADDRESS: E., /3718, a ( /200f)
CITY/STATE/ZIP:L 1( X )KC(/'I Q / OA} PARCEL NUMBER:
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OWNER:(1),x(7`' "% PHONE NUMBER:
MAILING ADDRESS: U
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CONTRACTOR: F/1 rLu nr fln4--cn O i LICENSE
PHONE
MAILING ADDRESS: . [ J0 J-uLQJL)
(Street)
e
(City/State) (Zip)
NUMBERI ./ r��S 4� ..
NUMBER: 4% /' C)
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( ity/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER
OF UNITS
DESCRIPTION
X EACH
UNIT
= AMOUNT,
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIING (5 OR MORE. EACH:)
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
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
1
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 4.00 =
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 =
x106.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
I fl .o(5
NOTE:
SIGNATU•E /�O ���, 1//
INIMUM PERMIT PEE I8 $35.00
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Spokane County Department of Buliding and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675