1993, 01-27 Permit App: 93000396 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM �� b
Information Worksheet
JOB STREET ADDRESS: E 12820 Skyview 6-/9/ C
CITY/STATE/ZIP: Spokane, WA 99206 PARCEL NUMBER:
OWNER: Dennis Lee PHONE NUMBER: ( 509 ) 927-4322
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: Steinmetz Heating & A/C LICENSE NUMBER: STEINHA147KF
PHONE NUMBER: ( 509 ) 922-2034
MAILING ADDRESS: N 2114 Pines Rd. Suite 3 Spokane WA 99206
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UUNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER ( x 10.00 = 10.00
HEATING EQUIPMENT <100,000 BTU ( x 12.00 = 11.•00
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING .(EA OUTLET) Z.. 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 =
AIR HANDLER >10, 000 CFM x 15. 00 =
SUBTOTAL $ a4.O3
PLUS : PROCESSING FEE + $ 25. 00
EQUALS : TOTAL PERMIT
NOTE: IN.IMUM PERMIT FEE IS $35 . 00 FEE DUE = $ I.E.q•00_j
SIGNATURE
Spokane ounty Department of Buildingand Safety
West 1303 Broadway Avenue Spokane, WA 260 (509) 456-3675