1993, 01-05 Permit App: 93000027 Mechanical Fixtures CU3- oz. 7
MECHANICAL PERMIT APPLICATION FORM 3S
Information Worksheet
R
JOB STREET ADDRESS: E 4i2c (I ���V le` L
CITY/STATE/ZIP: 1(Q PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(S reet) (City/State) (Zip)
CONTRACTOR: I ucf fie ( Reck-\---1 V 3 LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
x 25.00 =
GAS WATER HEATER x 10.00 = O, p--ci)
2. =
>�A5€fQUIPttiAgt�'I'gt Q�!�P .:1NGLt7;;;;;;;�::.::.;:.;::::.;;>:.;:.: ::.:<.:;:
x 12.00
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
1
x .00 =
C7Z�
BOILER/REFRIG 1-100M BTU x 12.00 =
x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
:::::::,.:.:::.:::::::::::::::::...::...:............................:..:.:::..........
x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HAAT•PU10�AIS.tONpiTl()Ntit111. Q.::.:V:.;:.;:.;;:.;;;;:.::;;;:.;:.::..:
x
12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
2 .00 =
HEAT pl�Mp AtE#��NL��TI061EI�y$-�tJt'1`Q.;:.:.��.;;;:.;:.:.;::,:.:_:.;;;:.;:
x 5
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
;:H SAS:tUEtii$110iniiP.04DITN 0ECOO:.:0..;;:;:.::.:::.::.:::::>:.;:.;:.; :,:
x 60.00 =
VENTILATING FANS x 10.00 =
x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
x 10.00 =
CLOTHES DRYER x 10.00 =
1
x 000 =
GAS LOG x 10.00 =
.MtSGgL0NRCXMA.NprCqgEaSLS.,E" }igH:.;;;:.::;;;:.;:.;;::.
x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
1
x100.00=,1LINSTEI:�+GAS AF�I�[.tAN���►4QQ�t�t�0 '�'U,>;:.;:,>;:.;.;;;:.......
USED APPLIANCE<400,000 BTU x 50.00 =
1 0=
N G>= dt�.�,0�(1!.:.......�............................
x 000
AIR HANDLER<10,000 CFM x 12.00 =
x5
15.00 =
SUBTOTAL $ (l• OD
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ c(,DU
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675