1990, 01-25 Permit App: 90000332 Mechanical Fixtures�iCNACA.. :1CATION FORM
Information Worksh et
JOB STREET ADDRESS: 5d2.� 5= �r
CITY/STATE/ZIP: .S , t 4) CEL NUMBER:
OWNER: /4 /ter M•� r�r'i �i .. a r PHONE NUMBER:
MAILING AD SS: .50 0 A t>hi�/5�- /91 417/1 Al .49 %gZc7
(Street) (City/State) (Zip)
CONTRACTOR:
1&)t Lt,, /9 LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS tTNIT
DESCRIPTION
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER- _ _ ETU
HEATING EQUIPMENTT<100,000 BTU
HEATING EQUIPMENT +100,000 BTU -
GAS PIPING (EA OUTLET)' ,_, _ _ _ _ _
REFRIG 1-100M BTU (NOT AYE OR HEAT PUMP)
REFRIG 101-500M BTU_ _
REFRIG 501-1,000M BTU:-
REFRIG 1,001-1,750M BTU
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 2I HOOD
CLOTHES DRYER_
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)._
UNLISTED GAS APPLIANCE <400,000 BTU_
UNLISTED 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
MORI
.1011 AM.
(Zip)
= AMOUNT
X$10.00 =
x 25.00 =
x 10.0,0 =
x 12.00
x 15.'00
x 1.001
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 =
SUBTOTAL
PLUS: PROCESSING FEE
$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
Spokane County Department of. Buitdin4 and Safety
West 1303 Broadvav Avenue Spokane, WA 99260 (5 9) 456-3675
= $