1990, 12-10 Permit App: 90006663 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS : /in 9r/* 5/;v7-4",
CITY/STATE/ZIP: h,� /�� PARCEL NUMBER:
OWNER: r/Me/' ,444%r,1-/ /�/ (9�4, PHONE NUMBER:
MAILING ADDRESS:
CONTRACTOR:
(Street)
MAILING ADDRESS:
d -Y_ 7616
06
7076.- doa6
(City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
.DESCRIPTION OF UNITS UNIT
DUCTWORK SYSTEM
WOODSTOVF/INSERT
GAS WATER HEATER
HEATING.EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
.GAS PIPING- : (EA OUTLET) •
REFRIG.1-100M BTU (NOT A/C OR HEAT -PUMP)
REFRIG:101-5001 BTU
REFRIG501-1,000M BTU'
REFRIG-1,001-1,750M BTU
REFRIG`.+1050M BTU
HEAT.:PUMP & AIR CONDITIONER 0 -3 --.TONS -
HEAT PUMP & AIR. CONDITIONER.3-15 TONS _
•HEAT PUMP°& AIR CONDITIONER 15-30 TONS _
HEAT. -PUMP & AIR: CONDITIONER 30-50.TONS _
HEAT PUMP &•AIR CONDITIONER +50 TONS
VENTILATING FANS..
EVAPORATIVE COOLERS
TYPE I'HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)_
UNLISTED GAS APPLIANCE <400,000 BTU_ _
UNLISTED GAS APPLIANCE >400,000 BTU_
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
= AMOUNT
x$?0.00
x 25.00
x 10.00 =
x 12.00 =
x 15.00
x •1.00
x 12.00 =
x 20.00 _
x-25.00
x 35.00
x 60.00 =
x 12.00 =
x 20.00
x 25.00 =
x 35.00 =
x 60.00
x 10.00 =
x 10.00=
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
$
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675