1993, 06-25 Permit App: 93004979 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
C/ Information Worksheet
JOB STREET ADDRESS: 397/ 5. Si Iv how ,D g ,
CITY/STATE/ZIP: E X KA toe, '� 1 gq 2 66 PARCEL NUMBER: n (,
OWNER: hl J K2" T 14 A L RV PHONE NUMBER: 9a C -
MAILING ADDRESS:
A (Street) (City/State) (Zip)
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CONTRACTOR: / , 0 " ' r\.� Al EL- LICENSE NUMBER: Uv1 L L 1 s(S
' r Ii PHONE NUMBER:
MAILING ADDRESS: Pa ` ` gsV A N)e, A g qj/
(Street) I(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 = /D-B O
GAS EQUIPMEN ' 100,0OQ: TU:(IN UD ::: / x 12.00 = /2•e 0
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
;SAS PIPING( /?►OI TL .::::: x too = Q?-C--G
BOILER/REFRIG 1-100M BTU x 12.00 a
x 20.00 a
BOILER/REFRIG 501-1,000M BTU x 25.00 =
,POJLER/REF II01,pcO1.1 750M BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
............ ........................................................... ............................ ...............................
HEAT PUMP& IR CONDITION R Ate$TONS x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
ki ll PUMP&.AIRVONQITIONE1 15-30 TONG x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 •
;kl> AT PUMP&AIR CO DITIONERa50 TOMS x 60.00 =
VENTILATING FANS x 10.00 =
VAPQ iAT .QQQL pS....... x 10.00 =
TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 =
PE II NOOK x 10.00 =
CLOTHES DRYER x 10.00 =
x 10.00 =
.n......... r.............. :S+r:•::?Sc:C:vwi.+>.'vtitii::f:i;ii iiiii:is i::i:ti:::i:iii:v:ii: ':•iiii:i iii:::Jiiiiii':i:`i:ii:
GAS LOG x 10.00 =
1ISCEL EOUS(NOT COV R D F S WH R x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
1 ,INST D G ,S PP ANCE 400, 00 BTU x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
US D 11PP .1 ►NG , 00.000:BTU::.:.... x100.00-
AIR HANDLER<10,000 CFM x 12.00 =
AIS HANDL. 0 OP0 CFM:... ... ..: x 15.00
SUBTOTAL 1 $ L'06
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE _ 1/91 D U
SIGNATURE5/k_j
-- 42`�
Spokane County Division of Buildings
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