1992, 06-19 Permit App: 92004528 Mechanical Fixtures ova- yS2
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet 1
JOB STREET ADDRESS: _ 4 7 11 S\,4
CITY/STATE/ZIP: c tom. a0,b PARCEL NUMBER:
OWNER: \K..)•@; \\.Q v 1.' CIS PHONE NUMBER: -i p2,L9 o o ) '
MAILING ADDRESS: , �-� -j � � r�°c'l - �� r ,O b
(Street) i (Ci y/State) (Zip)
CONTRACTOR: E‘v.sc.vevc\� leker���►1cL,LICENSE NUMBER: E11Q1C 171OZ,�-
PHONE NUMBER: S-3S- LI 5 ,_3
MAILING ADDRESS: I Q D.„a �Z vim.. r�► (4143
(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 x 10.00 = 10 , oD
HEATING EQUIPMENT <100,000 BTU x 12.00 = f .DO
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4.00 = 06'
GAS PI?ING (5 OR MORE. EACH: ) 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 =
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 =
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 $ b,®0
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT^
NOTE: MUM PERMIT FE IS $35.00 FEE DUE = $
SIGNATURE
Spokane County partment of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675