1992, 04-17 Permit App: 92002640 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
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JOB STREET ADDRESS• r I&0/7 ova__
CITY/STATE/ZIP: 44, :A L /.0& PARCEL NUMBER:
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OWNER: kC175 C- / PHONE NUMBER: j?pZ cif/(v
MAILING ADDRESS: _
(Street) (City/State) (Zip)
CONTRACTOR: 4 -? .c! 1, /ap LICENSE NUMBER: J/JE .5)i-�C /d ooy.
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MAILING ADDRESS: ("(9C) !/ -�-� •7-- ' -0795�/2-
(Street) ( ity/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER / x 10.00 =
HEATING EQUIPMENT <100,000 BTU / x 12.00 =
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (EA OUTLET) ;3 x 1.00 =
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00 =
REFRIG 101-500M BTU x 20.00 =
REFRIG 501-1,000M BTU x 25.00 =
REFRIG 1,001-1,750M BTU x 35.00 =
REFRIG +1,750M BTU x 60.00 =
HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ x 12.00 = _
HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20.00 =
HEAT PUMP & AIR CONDITIONER 15-30 TONS _ x 25.00 =
HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35.00 =
HEAT PUMP & AIR CONDITIONER +50 TONS _ _ x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE COOLERS x 10.00 =
TYPE I HOOD (PER 12 ' OR 12 ' PTN. OF HOOD) x 50.00 =
TYPE II HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE x 10.00 =
GAS LOG / x 10.00 =
MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ x 10.00 =
UNLISTED GAS APPLIANCE <400,000 BTU_ _ _ x 50.00 =
UNLISTED GAS APPLIANCE >400,000 BTU_ _ _ x100.00 =
USED APPLIANCE <400,000 BTU x 50.00 =
USED APPLIANCE >400,000 BTU x100.00 =
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER >10,000 CFM x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE _ $
SIGNATURE
Spokane County Department of Buildin_gq and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675