1990, 08-15 Permit App: 90003967 Mechanical Fixtures MEC ItAN1CAC'PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: S, /'7g rj k o c k l k t q ri
CITY/STATE/ZIP: SPoKHnJE1I-0iU . y72/2- PARCEL NUMBER:
OWNER: 'T/3 c K Ceye_ PHONE NUMBER: ..6-35- 5-3Ya
MAILING ADDRESS: S . 17 L 7 f ockr eiq1 y-e sr, ,mNc, w' 7//2_
(Street) (City/State) (Zip)
CONTRACTOR: ,4NDaN S SUEE7 rY/ET,LL LICENSE NUMBER: /1/UDtcS,e115-111(Z
PHONE NUMBER: 9 p-d 9 6 D
MAILING ADDRESS: t, /37303 %,W646-,4Ve SP9 K19/l/Et w,j 72/6
(Street) (City/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 = /a- pro
HEATING EQUIPMENT +100, 000 BTU x 15. 00 =
GAS PIPING (EA OUTLET) / 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 $ / 3 . vo
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35. 00 FEE DUE = $ 38% N
SIGNATURE
Spokane County Department of Buildingand Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675