1992, 10-28 Permit App: 92009463 PipingLii-O
MECHANICAL PERMIT APPLICATION FORM n £innniAt,,,
Information Worksheet ga'clg6.316't(14A-VI-424"\-"0
JOB STREET ADDRESS: „.3.5-75 . j/ ��AV,3985
CITY/STATTE/ZZIP:%.9411.9
z2//eiWPARCEL NUMBER:
2
OWNER: J //c7 a in I (11) PHONE NUMBER: i_5-7-5-75-
MAILING
57-s7S
MAILING ADDRESS:
(Street)
CONTRACTOR:/S F Js ' We -A-
,q71"
(City/State) (Zip)
LICENSE NUMBER:%(/C/74,// / •7j /7J (
'/fl -moo /
PHONE NUMBER:
MAILING ADDRESS: £ _3/0:2 2 €Y% 5-S
(Street)
o 4/4
t ity/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
-- -•
GAS PITTING (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
3AS LOG
4ISCELLANEOUS (NOT COVERED ELSEWHERE)
JNLISTED GAS APPLIANCE <400,000 BTU
JNLISTED GAS APPLIANCE >400,000 BTU
JSED APPLIANCE <400,000 BTU
JSED APPLIANCE >400,000 BTU
%IR HANDLER <10,000 CFM
kIR HANDLER >10,000 CFM
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 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
(
/,
/erne
SUBTOTAL
$ /, 9-'
PLUS: PROCESSING FEE
+/$,,--25-t013.,,
EQUALS: TOTAL PERMIT
DUE
/
= $ • or"m., i
NOTE: MI TMUM FEE IS $35.00FEE
�i-�
Spokane County Department of Building and Safety -2
(sc.
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675