1992, 09-04 Permit App: 92007271 Range, Piping MECHANICAL PERM,IT APPLICATION FORM r-I Z_ 1 2 :7 /
Information Worksheet
JOB STREET ADDR '/% E. �S�A
CITY/STATE/ :`� i) • Cx_�� PARCEL NUMBER:
OWNER: y� �'� _ .qz /Z�,.7I.) PHONE NUMBER: - �(, 3
MAILING A RESS. n10?-ef.)FAN 1`Io2.Z--
(Street) (City/State) (Zip)
2f( "CONTRACTOR: 7i0 re ,___?47/Z LICENSE NUMBER: JC/(XC)/ f)7)OI Z-
PHON UMBERti-��11"-/92
MAILING ADDRESS: 6 . _5./(,),3 /h O l1 9 /,2_(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WDOASTOVE/INS> RT '" x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT*;00,000$TU(INCLIUDES , < ` x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTt;I �y x 1.00 = /•U(J
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REFRIG 10l 500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
ROI LERIPEERIG 1,0001. 1,750M STU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP &AIR CONDITIONERO 3 TONS _ x 12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP &LAIR CONDITIONER15-30,TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
::HA:r PUMP&,AIR CONDITIONER+50 TUNS 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 = /I/. 0 0
x1000
GAS LOG x 10.00 =
MISCELLANEOUS (NOT COVERED ELSEWHERg x 1,0.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.b0 = -
ULINSTED GAS APPLIANCE 3.400,000 BTU x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 = _
USED APPLIANCE X400,040 BTIU ; x100.00 = -
AIR HANDLER<10,000 CFM x 12.00 =
AIR HANDLER>10,000 CFM x 15.00 =
SUBTOTAL $ //,(f
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTAL PERMIT FEE DUE _ $ 4("(,
a-)
SIGNATURE 41 e i N o2co h A A- 1 o as
Spokane County Division of Buildings
It/vast 1- 'Broadway Avenue Sookane. WA 99260 (509) 456-3675