1993, 05-13 Permit App: 93003478 Mechanical Fixtures .
MECHANICAL PERMIT APPLICATION FORM
q ' Information Worksheet
JOB STREET ADDRESS: S S . 17 I 1 Roc KYRlN
CITY/STATE/ZIP: SPO 16,L()I1 CI logq PARCEL NUMBER:
OWNER: RPcRL.E1 DOIkCEIASS PHONE NUMBER:
MAILING ADDRESS:
SMITHG (City/State) (Zip)
CONTRACTOR:
E. 1�2 NO�?1 LICENSE NUMBER:
SPOKANE,WA 99207
(509)328-4431 PHONE NUMBER:
WAYNESH258NJ
MAILING ADDRESS:
(Street) (City/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 x 10.00 =
GAS EQUIPMENT<100,000 BTU (INCLUDES x 12.00 =
GAS EQUIPMENT +100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTLET) x 1.00 = A. 00
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REFRIG 101-500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x25.00 =
BOILER/REFRIG 1,0001-1,750M BTU x35.00 =
BOILER/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 x10.00 =
CLOTHES DRYER x 10.00 = 16.00
RANGE x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS (NOT COVERED ELSEWHERE$$Q, I x 10.00 = /6.00
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED 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
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE = $ 4/1 DO
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SIGNATURE ''i �«, b. ,
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675