1991, 05-21 Permit App: 91002743 Mechanical Fixtures P
1-qo
MECHANICAL PERMIT APPUCATION FORM . ( , 1 '
Information W rksheet ( i111
JOB STREET .ADDRESS; l Q,E3 LLD
CITY/STATE/ZIP: . ,; 1wv�.- P.RC NUMBER: = ?0r
OWNER: PHONE NUMBER: 6' 2-41-Sidn52.'(
MAILING ADDRESS: h,0aT14---4
(Street) (City/State) (Zip)
CONTRACTOR:F60e.xoN S LICENSE NUMBER: U1-14-tka 8-2
PHONE NUMBER: 92.40.---S ,
'
MAILING ADDRESS: C uS l". yiti a.,,�.j � 3 'lc Zpi.
(Street) (Ci /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 =
HEATING EQUIPMENT <100,000 BTU l x 12.00 = ! Z.ees
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4. 00 =
GAS PIING (5 OR MORE. EACH: ) 2 x 1.00 = Z.�.
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 = t o'101-
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 $ ao-
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: N NIXON P RMIT FEE IB $35.00 FEE DUE = $ 4411_..
SIGNATURE ✓ZT
1.
Spokane County Department of Building and Safety