1989, 09-29 Permit App: 89003690 AC pry
MECHANICAL PERMIT .AR.PLICATION FORM C��ws �
Information Worksheet Ac`,-P-1 (�
JOB STREET ADDRESS: l: O L/ 6SOd
CITY/STATE/ZIP: l U , (A)O, . CC12t) PARCEL NUMBER: 7<,g1/1 - _O j
OWNER: { kJO y PHONE NUMBER: q `7
MAILING ADDRESS: ,i0
(Street) City/State) (Zip)"
CONTRACTOR: Q _ - LICENSE NUMBER:
PHONE NUMBER: M-02) 32-0
MAILING ADDRESS:7•() 3")04-1)
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25. 00 =
GAS WATER HEATER x 10. 00 =
HEATING EQUIPMENT <100,000 BTU x 12.00 =
HEATING EQUIPMENT +100, 000 BTU x 15. 00 = •
GAS PIPING (1 - 4 OUTLETS) x 4. 00 = •
GAS PIING (5 OR MORE. EACH: ) x 1. 00 = .
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00 =
REFRIG 101-500M BTU x 20. 00 =
REFRIG 501-1, 000M BTU x 25. 00 =
REFRIG 1, 001-1,750M BTU x 35. 00 =
REFRIG +1,750M BTU x 60. 00 =
HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ x 12.00 =
HEAT PUMP & AIR CONDITIONER 3-15 TONS _ '� u2_ x 20.00 67V)611)
HEAT PUMP & AIR CONDITIONER 15-30 'PONS _ 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 T HOOD (PER 12 ' 12 ' TTN• ' _
- ��..�, vi. PTN. OF iivvuj 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 10. 00 =
UNLISTED GAS APPLIANCE <400, 000 BTU_ _ x 50. 00 =
UNLISTED 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 $ eJ°
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT!
NOTE: MINIMUM PE FEE IS $35.00 FEE DUE _ $
SIGNATURE `� W "�
Spokane County epartment of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675