1992, 09-08 Permit App: 92007324 Mechanical Fixtures �I off• oo� �` +d MECHANICAL PERMIT.APPUCATION FORM 9. cf
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Information Worksheet �j
JOB STREET ADDRESS: �"r' /- >/' 7' '4(49 J
CITY/STATE/ZIP.41 l( r• WA/// PARCEL NUMBER:
OWNER: k) ( 1i 672 .415 PHONE NUMBER: �%� r' '�
MAILING ADDRESS: 59 77 / ,171V6/f
(Street) (City/State) (Zip)
CONTRACTOR: 13 A-rt-m w sVo--L LICENSE NUMBERt: .Q 1 ► o K L
PHONE NUMBER: q2'L.- Sac
MAILING ADDRESS: - t\9 LL PI-61 S t.s.p_A -Or:3 csb - •.\/VAS.vk Cr--CrZO�f
(Street) (Ci y/State) (Zip)
mmimmummisimmilimma
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 = / G�
HEATING EQUIPMENT <100,000 BTU I x 12.00 = /„
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4.00 =
GAS PIING (5 OR MORE. EACH: ) A) x 1.00 = 4. CSC%
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 =
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 = 'z
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 $ �rr'1jfoZ
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: MIN `'
IIM PERMIT FEE IS $35.00 FEE DUE = $ 9(
SIGNATURE ,�
Spokane County Department of Building and Safety_- ____