1994, 08-03 Permit App: 94007376 AC MECHANICAL PERI1 'IT APPLICATION FORM
Information Worksheet /
JOB STREET ADDRESS: '/Y' /� 'fL) I'V S . .� (�4 3 l .
CITY/STATE/ZIP:C f1 ns,, kick .f,JQ l PARCEL NUMBER:
OWNER: rr e3 ' .r:?e� PHONE NUMBER: 7., -
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: Jt' .,- -r r � �c �u LICENSE NUMBER:A)O,e(4 4 07 �C /
/ PHONE NUMBER:E 5 -?1)/- 497
MAILING ADDRESS: K S in 7 � ?�'"o ���G� 97 °)./ �_
(Street) (City/gtate) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 -
WOODSTOVE,/INSERT x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT<100,t C 87U(INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING(EA OtTL ').... .:. . .. ......... .. .. x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/ EFRIG 101. 500M BTU... x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOI ERIE FRiG:1,0001; 1,750M'BTU x 35.00 -
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP AIR CONDITIONER 0-3 TONS f 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 X50 TONS x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE`DOOLERS 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 =
MISCELLANEOUS(NO`I''COVERED'ELSE:WHERE`:; x 1.0.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.()0 =
ULINSTED GAS APPLIANCE>400000 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 $ /aJ, o
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
p FEE DUE = $37, o o
SIGNATURE i��,i -J1 .-- -
Spokane County Division of Buildings
West 131 •'way Avenue Spokane, WA 99260 (509) 456-3675