1992, 07-08 Permit App: 92005065 AC A y
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: fi ) /`V ( 5i2 ' C-, t)
CITY/STATE/ZIP:S/)G. 1,(9 9 /;2 PARCEL NUMBER:
OWNER: y%)/)T &)>9019C.F; PHONE NUMBER: 9,2 7--
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: IUB ICO 14CA7/./06 LICENSE NUMBER: OC)2CP HA 17n r?z
PHONE NUMBER3L
MAILING ADDRESS: £ .5/6,.3 /ri.%
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
0
x25.00 =
...... ....... ........................ .
GAS WATER HEATER:::::............................................... ................ .... x 10.00 =
x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
A
x 0
1. 0 IPI T '
................ ............................................
......:..:...................
BOILER/REFRIG 1-100M BTU x 12.00 =
BO,ILER/REFRIG 101-BOOM BTU..:....` :`: :`:::.;':.:' :<;'`'; : x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP AIR NDI I1ONER 0 TONS: ...... ... �► x 12.00 = /02 61
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP &AIR ONDITIONER>15 30'TANS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT DUMP&At( CONDITI NER+50 TONS : ; .'`':: x 60.00 =
VENTILATING FANS x 10.00 =
x1 =
TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 =
x 10.00 =
.......:..:.....:::.:.:..........................................:........................................................................:.
CLOTHES DRYER x 10.00 =
RANGE x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS(NOT.COVERED ELSEWHERE >'a `'. x 1,0.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTEf +SAS APPLIANCE 4 0 J00 >`;`:>: ` x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>400000 BTU: ,. [ x100.00
AIR HANDLER<10,000 CFM x 12.00 =
AIR HANDLER>10,000 CFM x 15.00 =
SUBTOTAL $ Cb
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT 7. cm
FEE DUE = $
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675