1990, 06-15 Permit App: 90002761 PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet '\
JOB STREET ADDRESS: �. (� / n.c.) L J l l ci s!, e cm
CITY/STATE/ZIP:J k0 1 ( ,l In c&a0 PARCEL NUMBER:
OWNER: Sv S { rYm C) s}- l c / Y i lc t
MAILING ADDRESS: c)t /YY
(Street)
PHONE NUMBER: I/
e
/� (City/State) (Zip)
JCONTRACTOR: Gf 7GY J figaA ,- LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL. WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS 1TNIT
DESCRIPTION
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.. 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 4. 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 II 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
= 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 =
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 =
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 Broadway Avenue Spokane, WA 9260 (509) 456-3675