1992, 07-21 Permit App: 92005518 Mechanical Fixtures ,- `` 1 I 1 cLLV t --t-e) ELT
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MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: .(.�-C± l a(oI 6 . �tQcc) f2--s5/6
CITY/STATE/ZIP: , LCC
� A 99, //I cp PARCEL NUMBER: '. o!/2-
OWNER: 9üi4ini / �C� PHONE NUMBER: 9A4 4 — o// 5/
_-____-_,
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: A$cM QUALITY HEATING LICENSE NUMBER: _Amtwo xt9ui
r 1PreniZikVAVE. PHONE NUMBER: 92fl-non
SPOKANE; WA 99216
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION OFFUUNBIITTS xUNITH - AMOUNT
DUCTWORK SYSTEM •X$10.00 -
WOODSTOVE/INSERT x 25.00 -
GAS WATER HEATER • (0,_0()X 10.00 • (0,
HEATING EQUIPMENT <100,000 BTU _ _ _. / X 12.00. - / Z ,0 n
HEATING EQUIPMENT +100,000 BTU x 15.00 -
GAS PIPING (EA OUTLET) oL x 1.00. - ,Q . 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 is
AIR HANDLER >10,000 CFM x 15.00 -
SUBTOTAL $ ,A41‘ 00
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMITT
NOTE: M N U PE T FEE IS $35.00 FEE DUE = $ qD 0
SIGNATURE_: - ,
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675