1993, 01-05 Permit App: 93000009 Mechanical Fixtures 4 .
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Information Worksheet �� Q
BSTREET ADDRESS: 4 '2/ '2 S. , (Alb );;--4 ---A-
CITY/STATE/ZIP:\a a ../ L-4- . PARCEL NUMBER:
OWNER: `'U '?.212 -e..- ('/Z.Q-(%Y PHONE NUMBER: Q ? '7- ,:2 97s---
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MAILING ADDRESS: )�
(Street) (City/State) (Zip)
CONTRACTOR: 6A-4...-101.31 P +- M t. 4 LICENSE NUMBER: g To k},4 i i o Q Z_
PHONE NUMBER: Zt- Sec v
MAILING ADDRESS: ( 1‘,au- Pt..I S F L.2.31 csi V 3 ca s�-re..-.-V.004.* Ce-4 ICJto
(Street) (Ci y/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 = /0 , 0)
HEATING EQUIPMENT <100,000 BTU / x 12.00 = i , 00
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4.00 =
GAS PIING (5 OR MORE. EACH:) . x 1.00 = . OL'
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 HOOD1 __ 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 $ ? • On
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: MIXIMUI[ p T VEE ; 35.00 FEE DUE gm $ ,
SIGNATURE /1Li ) 5 .4-c,L' d,t_., _
Spokane County Dmiartuent of OMAN and -- •-- ----