1994, 07-22 Permit App: 94006920 AC MECHANICAL PERMIT APPLICATION FORM C4' lo qZ-0
Information Worksheet
JOB STREET ADDRESS: s, o o I, �_.„Q.,-z,„ cr ti
CITY/STATE/ZIP: S �v /1, PARCEL NUMBER:
OWNER: y-r2� 1�O�i aM PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: I)) (- -c /J. t-i LICENSE NUMBER:
i PHONE NUMBER: 5 'i 419 7 5
MAILING ADDRESS: 3 _� b_2 9 f /
(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 QUIPMENT 100 0001 TU(INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
x 1,00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
BQILER/REPRIG 101 '500M 7U...... !: x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILERIR FRIG;; ,000 -1,75 M BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP!I<`AIR CONDITIONER 0-3 TONS / x 12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
NEAT PUMP AIR CONDITIONER 15-30 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP&AIR CONDITIONER +50 TONS x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE COOLERS 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(NOT COVERED ELSEWHERE'- x 1,0.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.1)0 =
ULINSTED.GAS APPLIANCE>400,000 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 $ )S. Oo
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE = $437, 00
/ i
SIGNATURE i � /J /
Spokane County Division of Buildings
West 131 'way Avenue Spokane, WA 99260 (509) 456-3675