1992, 12-03 Permit App: 92010595 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM `- z ` F3
Al1a�mation Worksheet
JOB STREET ADDRESS: U , /(2// A f
CITY/STATE/ZI : !Spr, CL'/q917. PARCEL NUMBER:
OWNER: (VC - PHONE NUMBER: 9� 7-( 5
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR1'RCO I 4Vc_.; j LICENSE NUMBER: QLf,(CC'/f17/7C,f '
PHONE NUMBER: 534/---4/62 2S-
MAILING ADDRESS: -"‘. 713 /fC€/i/ r\512). LLW 997/-2
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
W : IOQ.
x 25.00 =
GAS WATER HEATER x 10.00 = /dr CQ)
GAS I"QUIPMIANT<100►t7rOt BTU(INCLUDES x 12.00 = /5,2,
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIFIhIG ,�A QIiTIR- x 1.00
BOILER/REFRIG 1-100M BTU x 12.00 =
x 20.00
............................:.: . ........:.
BOILER/REFRIG 501-1,000M BTU x 25.00 =
.............................................
Bt ILERIREF IG 1,00t 1�-1, 50M BTE1 x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
H AT PUMP& IR ONDITIONER TONS %` :<`:` x 12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP:&AIRCO:NDITIONER +50:TONS. .. . : :":` x 60.00 =
VENTILATING FANS::::::................................................................................ x 10.00 =
x 10.00
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
x 10.00 = .
CLOTHES DRYER x 10.00 =
lA`
x 10.00 _
GAS LOG: .: . ................................................ ............................................ x 10.00 =
.....................................................::.::.................................................
MISC LL AN OUS�NQT Ct71FERED ELSEWHERI= x 1,0.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.t 0 =
ULINSTED GAS APPLIANCE 400, 00 BTU x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIAN E 000 STU x100.00=
... ....... ..:
AIR HANDLER<10,000 CFM x 12.00 =
AIR;HANDLER>10,000 CFM:> x 15.00 =
SUBTOTAL $ #2c/(i)
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ (1. C)
SIGNATUREf
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675