1993, 01-12 Permit App: 93000146 Mechanical Fixtures • MECHANICAL PERMIT APPLICATION FORM
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Information Worksheet
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JOB STREET ADDRESS: ,)
CITY/STATE/ZIP 4 1 Are, 9 92e PARCEL NUMBER:
OWNER: Eem PHONE NUMBER: 9°) `� 6 7e?�
MAILING ADDRESS: (I
� (Street) (City/State) (Zip)
CONTRACTOR;! �4' t cat tit LICENSE NUMBER: A) � R&F 1( (v iD -1 '7
PHONE NUMBER: 9 - 4702 9
MAILING ADDRESS•v' /3 Lill 9 6Y 0--. , 3
(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 =
GAS:EQUIPMEN '+c l OQ,000 BTU.(INCLUDES:::. / x 12.00 - /c.2.66
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING F..A t�U L x 1.00 = /,0 O
.::::. ...:::::...........
BOILER/REFRIG 1-100M BTU x 12.00 =
FOIL R/AEFf G O OOM:ETU:.. x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
.........................................................................................................................................
x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
ti ►T FUME' AIR ONt ITIQN R 0- TONG x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
;HEATPUMP&.AIR.CONDITIONER 15-30 TONS.... >:<:>` x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
HEAXPUMP&AIR CONE il'ION R t 0 TOMS. 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 =
FANG x 10.00 =
................. ......
GAS LOG x 10.00 =
..........................................................................................................................................
MMISC.ELLANEOUS;.(NOT COVERED ELSEWHERE . , x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00
ULINSTED GAC APP .IMNC IQ0 000 ........... .. x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPI GE 00,0OO ST I:: x100.00
AIR HANDLER<10,000 CFM x 12.00 =
nig HANDL . 10 CFM x 15.00 =
SUBTOTAL $ /3 p(3
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT D0
FEE DUE =$
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SIGNATURE . /Y 6-
Spokane County Division of Buildings
West 13n3 Rrnadwav AVAn11A SnnkanA_ WA 9926n (Fn91 456-3675