1991, 08-15 Permit App: 91004727 AC MECHANICAL PERMIT APPLICATION-FORM
Info/rmati.n Worksheet
JOB STREET ADDRESS: P/ i -- //-72i
CITY/STATE/ZIP: ' / .0 A,1 . A . KC NUMBER:
OWNER: ,c-79A/ S I PHONE NUMBER: - 7- 3'
MAILING ADDRE S _ - ( -
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER: AMQUAHE193N1
PHONE NUMBER: 928-2100
MAILING ADDRESS:
(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 =
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 = fa, O
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 $ (02_o d
/e_ % a • / L' PLUS: PROCESSING FEE + $ 25.00
I
EQUALS: TOTAL PERMIT
NOTE: M I ` •ERMIT FEE IS $35. 00 FEE DUE = $37/06
SIGNATURE I
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675