1991, 07-26 Permit App: 91004545 AC MECHANICAL PERMIT APPLICATION FORM
Information Worksheet 649
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JOB STREET ADDRESS: EF - 10�" q O SS
CITY/STATE/ZIP:S (4,14 [ ? RCE NUMBER: rise./ i-' 02/4L
OWNER: (114/114 PHONE NUMBER: g r _D 6 -s
MAILING DDRESS:
(Street) - (City/State) (Zip)(
CONTRACTOR: LICENSE NUMBER: A/vi 1.«)Ng /93 N
M ildi y � f �C Ea h1 NUMBER: F-0/ 0
E. 12710 Indiana PHONE
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MAILING ADDRESS• Spkane, Washington 99216
. (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 - - - ,; X10.00 . =
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 = )9 �.
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 +5 TONS _ x 60.00
VENTILATING FANS x 10.00
EVAPORATIVE COOLERS x 10.00 =
TYPE I HOOD (PER 12_' 47511-1T' 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 =
04,i1/ 61A1-1_ / ! SUBTOTAL $ /v( .Q 0
i
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE = $ 37(0V
SIGNATURE '"'\ C,, /
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675