1991, 06-24 Permit App: 91003570 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/IP:
OWNER: i
PARCEL NUMBER: 022 '/ - OS/D
PHONE NUMBER: L;7.c� f/
MAILING ADDRESS:
p(treet) (City/State) (Zip)
CONTRACTOR: 7e/aid f 41 d !4 S J C eLICENSE NUMBER: P/C c )1 R 1t,/ I C'O IffJ
PHONE NUMBER: ji.3 3 -3 e' ,f
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
•
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
1 : ILER/R I `: 01;;':: : M
C) ................. EI= � .1 �.. �-5��..... BTU ...................................
BOILER/REFRIG 501-1,000M BTU
BC t F RIG 1> 0001>� 1 750M>BTU <>« <=>
..................................................................................................................
BOILER/REFRIG +1,750M BTU
........................................................................................ . ........................
.................................................................................................................
CONDITIONER
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
#31N At CON[ ITIONis
VENTILATING FANS
.............................
...................................................................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
..............................................
CLOTHES DRYER
GAS LOG
............................................................................................................
MISCELlAN OC S (NOT COVERED ELSEV
UNLISTED GAS APPLIANCE <400,000 BTU
...............................
............................................................................................................
USED APPLIANCE <400,000 BTU
USED A;# LIANCE Q00 BT
AIR HANDLER <10,000 CFM
AIR HANDLER
NOTE: MINIMUM PE MIT FEE IS $35.00
SIGNATU
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00=
x 15.00 =
x 1.00 =
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 =
/
/2 .°1---
/
SUBTOTAL
$ / 3
PLUS: PROCESSING FEE
+ $ . 25.00
EQUALS: TOTAL PERMIT
FEE DUE
d AD
=$ 31
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675