1990, 04-10 Permit App: 90001355 Mechanical FixturesJOB STREET ADDRESS: / Q /
CITY/STATE/ZIP: 4.9-4L) ahl PARCEL NUMBER: D- .614 ( - � t I
OWNER: PHONE NUMBER: 9c9 -e- 5g./
MAILING ADDRESS: '45; 4-1.14/1eGldo t i* g '°1°
(Street) City/State) (Zip)
MECHANICAL -PERMIT APPLOTION FORM
Information Worksheet
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CONTRACTOR: "f '1k.e° ? )41,s7,9 -27f14- LICENSE NUMBER: y au.L°#/¢jaSTO
PHONE NUMBER:��S oZ Sc
MAILING ADDRESS: f / f
14/
(Street)
7d a-� h
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUM1
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS
3-15 TONS _
15-30 TONS _
30-50 TONS _
+50 TONS _ _
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER_ _
RANGE
GAS LOG
MISCELLANEOUS (NOT COVER LD 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
= AMOUNT
x$10.00 =
x 25.00 =
x 10.00
x 12.00 =
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 =
x35.00 =
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 =
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Department of Building_ and Safety
West 1303 Broadwav Avenue Spokane, WA 99260 (509) 456-3675