1990, 07-16 Permit App: 90003328 Mechanical Fixtures MECHANICAL PERMIT A PLICATION FORM ifp
Information Worksheet
JOB STREET ADDRESS: /' 7A'? (
CITY/STATE/ZIP: ,c)p�iitn„v
?a2./6 P�RCEL N&BER: 11/544-r45-0
OWNER: Lp 1/r S d C> (7-14.. .g a PHONE NUMBER: ?..4 - g3 5'7
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
, s �;rx ;� : :?: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 (EA' OUTLET) x 1.00
REFRIG;:.1100Mr BTU (NOT A/C _OR .HEAT.,PUMP), x 12.00
REFRIG 101,7500MrBTU x 20.00 =
REFRIG ;501''1 a00M<:;BTU-6- :f x 25.00
REFRIG- 1,001-1,750M,BTU • . - x 35.00 =
REFRIG +1,:750M BTU7.: _ _ x 60.00
HEAT. PUMP & AIR' CONDITIONER: 0 3 TONS x 12.00 =
HEAT PUMP &;.AIR' CONDITIONER`-3 15 ':TONS _ x 20.00 =
HEAT PUMP &-.AIR 'CONDITIONER';15-30: TONS 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 I HOOD •(PER 12 ' OR 12 ' PTN. OF HOOD) 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 $
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE = $
SIGNATURE
Spokane County Department of Building and Safety
West 13U3 Broadway Avenue Spokane, WA 99260 (509) 456-3675