1992, 12-21 Permit App: 92011087 Mechanical FixturesMECHANICAL PERMIT.APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: 3 T) - ' i ` A C L NUMBER:
OWNER: P i / ( rm - c i S' J (C
MAILING ADDRESS:�/c22( `..ai
CONTRACTOR:
MAILING ADDRESS:
PHONE NUMBER: K( --2L(' 32 l C?
e (,.* V 9` 2
(Street) (City/State) (Zip)
" (fAe; f'T )"c (75 LICENSE NUMBER: 4 47/1 S L-ec/c%' l
PHONE NUMBER: --<:2 2 ey y
(Street)
e .47
(City/State)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000
HEATING EQUIPMENT +100,000
GAS PIPING (EA OUTLET) _
REFRIG 1-100M BTU (NOT A/C
REFRIG 101-500M BTU
BTU..
BTU
OR HEAT PUMP)
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU_
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
EVAPORATIVE
TYPE I HOOD
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
AIR CONDITIONER
AIR CONDITIONER'
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS.
3-15 TONS -
15 -30 TONS
30-50.TONS
+50. TONS
COOLERS
(PER 12' OR 12' PTN. OF HOOD)
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$10.00 =
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 =
2_
3 n e -
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE 'v
Spokane County Department
West 1103 Broadway Avenue Snr''
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
quildin and Safety
WA 9260 (509) 456-3675