1993, 01-21 Permit App: 93000327 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM 2--,1
Information Worksheet
300c.
JOB STREET ADDRESS: / 7z.)--3 "3 . _.�l`'o f t L41 �l• ---
CITY/STATE/ZIP:0 0 t (A)A 9c10) f- 4RCEL NUMBER._
OWNER: (.i,(1 Y)LP Q R 6e L LLL' PHONE NUMBER:_ 5 � -C./ L/7,
MAILINGADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR (.1/C(J' et- lU LICENSE NUMBER: �ORin717)/ 701'1 Z,
PHONE NUMBER: c i 3L1 -/275
MAILING ADDRESS: E . .5/6itLI../16 (A),) 97 Zi--
(Street) ( ity/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER ' X EACH
DESCRIPTION OF UNITS UNIT_ = AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00-=
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER `i x 10.00 = / a
GAS EQUIPMENT<100,000 ATU'(INCLUDES: ;.(. . x 12.00 = /r2. (ID
GAS EQUIPMENT +100,000 BTU DUCTWORK) , x 15.00 =
GAS P PING (EA OUTI" Ty � ., x 1.00 = ( 2 d),
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILERIREFRIG 101'-500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU . " r x 25.00 =
BOILER/REFRIG 0001750M SI
, x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP &AIR CONDI,TIONER„Q-3 TONS:: x 12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP &:AIR CONDITIONER 1530 TONS x 25.00
HEAT PUMP & AIR CONDITIONER 30-50 TONSx 35.00
HEAT PUMP &AIR CONDITIONf R +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 1,0.00 =
UNLISTED GAS APPLIANCE<400,000 BTU ,,x 50.00 = _
ULINSTED GAS APPL,IANC_E>400,000BTU 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 $
J (I)
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT -
FEE DUE = cl/ ( W
f
b SIGNATURE_Z -- / 'l�
Spokane County Division of Buildings
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