1994, 07-22 Permit App: 94006892 ACJOB STREET ADDRESS:
CITY/STATE/ZIP • ` PARCEL NUMBER:
OWNER: 9..p. �l�-Y`-ems .' PHONE NUMBER: 7 '1- 7 6,
MAILING ADD SS:
/ (Street) , . (City/State) / / (Zip)
CONTRACTOR: A)4-,�-- iJ p,i --t-L-1,-1 LICENSE NUMBER: l'\) /) /,'/
' Ca i 01 4 4,
of
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
5
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i PHONE NUMBER: 53.c%- ).J9 )
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT
GAS WATER HEATER
GAS EQUIPMENT;<1001000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTL
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M OTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001-1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE.
GAS LOG
MISCELLANEOUS': (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x 10.00 -
x 12.00 =
x 15.00 -
x1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 1,0.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
/ z , (j c
x 15.00 =
SUBTOTAL
$10,00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$.r/.00
SIGNATURE
Spokane County Division of Buildings
West 131 'way Avenue Spokane, WA 99260 (509) 456-3675