1992, 08-11 Permit App: 92006294 Mechanical Fixturesells
� 3 � , mc\- MECHANICAL PERMIT APPLICATION FORM
(_� \ Information Worksheet
JOB STREET ADDRESS: -___=__\T--) , `A > I-1 tE., -3 i * S;VA *014
CITY/STATE/ZIP:\c--, l.t l ro.�; Ci au, , PARCEL NUMBER:
OWNER: \--).mac x-1 \ t 0V1 PHONE NUMBER:
MAILING ADDRESS: I C 1, L-1 ie '� l'1 tK:C C L;.:2,
(Street) (City/State)
\ (Zip)
CONTRACTOR: I:A \1 c:LX- Yi�.s1 \ ICLICENSE NUMBER: 1.=# 1 N` l-,rR,\k C \=7t,
PHONE NUMBER: 3 S
MAILING ADDRESS: I c z. 7'
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPM.!BTU (INCLUi ES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
Pi
BOILER/REFRIG
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REI=RIG 1,0001 1,750M BTtI ;:> :>
BOILER/REFRIG +1,750M BTU
HEAT PUMP ,& AIRONtITIONEi 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP.& IR CON ITIONER 15 3t TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP AIF ONDITIONEi +50 TONS>
VENTILATING FANS
EVAPORATIVE.COOLEI
................................................................................................................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
.....................................................
CLOTHES DRYER
......................................................................................................................
.......................................................................................................................
......................................................................................................................
GAS LOG
......................................................................................................................
MISCELLANEOUS (1 `I" COVERED. ELSSWHEI
UNLISTED GAS APPLIANCE <400,000 BTU
.......................................................................................................................
ULII STEI t 1S.APl EANCE>400,
.....::.........:.........................::...:..........::......................................:....................
USED APPLIANCE <400,000 BTU
.......................................................................................................................
USED APPLIANCE
AIR HANDLER <10,000 CFM
......................................................................................................................
AIR;H IDLE
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURt _� Ll
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
/;?,00
x 15.00 =
x1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
�
A 4 ti
SUBTOTAL
$ Me) c.)
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
y c)
= $ �l
Spoke County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675