1990, 12-13 Permit App: 90006752 Mechanical Fixturesb
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet, -
JOB STREET ADDRESS: Li 3 12 5. (v CSN i)(2A-
CIT_'/STATE/ZIP: .3(3160N -i €. L) -S(...( PARCEL NUMBER:
OWNER: M tN,(C. ).-(✓ 10 JVk
MAILING ADDRESS:
CONTRACTOR:
MAILING
PHONE NUMBER: I 2 ] - ZG g
(Street)
(City/State) (Zip)
jlv02T�Icti,�S %LF�(ZtG- t{-{WK.LICENSE NUMBER:!J RE 1= C 1 Q8�`'7
PHONE NUMBER: LK 3 ` S 7 S 2_
ADDRESS: EE. / 2:2-43 f )✓'--t_L�- w0f4 $051� - L0,.)06( 9q Z(‘
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UTNIT
.DESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING -(EA OUTLET)
-REFRIG..1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG:101-500M BTU
REFRIG501-1,0.00M BTU-
REFRIG1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT: -PUMP &
HEAT PUMP &
-HEAT PUMP-&
HEAT.PUMP-&
HEAT PUMP &
VENTILATING
•
AIR CONDITIONER 0-3 TONS _
AIR CONDITIONER.3-15 TONS
AIR CONDITIONER 15-30 TONS
AIR CONDITIONER 30750 TONS.
AIR CONDITIONER +50 TONS
FANS .
EVAPORATIVE COOLERS
TYPE I'HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE 'II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _
UNLISTED GAS APPLIANCE <400;000 BTU_ _ _
UNLISTED GAS APPLIANCE >400,000 BTU_ _
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <16,000 CFM
AIR HANDLER >10,000 CFM
= AMOUNT
x$? 0.00 ._
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 =
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 Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675