1993, 06-23 Permit App: 93004990 Mechanical Fixtures IVIECHANICAL.P7tRIVIIT APPLICATION FORM
G Information Worksheet
JOB STREET ADDRESS: L- ( 3 eb' SrJ/Ct- LA-tre.,
CITY/STATE/ZIP: G,r tk cAist)a 'a o)to PARCEL NUMBER: •
OWNER: 3 Acv ottCv1 -- PHONE NUMBER: 9°Z&'/3L, 5
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: rid 1 C t C/ C'.F,.1 f F-R LICENSE NUMBER: ( r)I co &tC. i %3 b L(
PHONE NUMBER: (_'iC)(t) 67:.2G �'%1 /
MAILING ADDRESS: ti • (!31 0,14(. `;J_ rii,.ic= ),i.=t c/92Cir
(Street) (City/State) (Zip)
._ MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
E-L ECTr ,,DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
4YOODSTOV�/Ii SER x 25.00 =
GAS WATER HEATER 1 x 10.00 = [a 00
GAS EQUIPMENT<100 000 TU (INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
02 x 1.00 = ., 00 _
BOILER/REFRIG 1-100M BTU x 12.00 =
_ECIL'F^Rf c c' lG:101..500 TU x20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
SCILI=F iREFRIG 1,0001 '1 �50M B t U x 35.00 =
BOILER/REFR►G+1,750M BTU --- -=--- • __! x 60.00 _ !
SEAT PUtrfP&AIR:CONDI CONDITION 0-3 TONS x 12.00
„HAAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT.PUMP:&AIR:CONDITIONER_15-30 T OSS x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS• - x 35.00 = ,
NEAT PUMP&AIR.CO IQITIONER +50 TON x 60.00 = _ •
VENTILATING FANS _ x 10.00 =
VAPORATIV COOL EPF x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00
TYPE, II HOOD a x 10.00 =
CLOTHES DRYER _ x 10.00 =
x. 10.00 =
GAS LOG I x 10.00 = /o- OD
MISCELLANEOUS(NOT COVERED ELSEWHERE x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTE 5 in nn B t
BAS A, PL, i�C� 0,,,�.�?J �T.S ;: x i Ou.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
_ o2.L 0o
`PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT
FEE DUE =$ �1
SIGNATURE
Spokane County Division of Buildings