1993, 08-10 Permit App: 93006833 Insert 43 - 833
MECHANICAL PERMIT APPLICATION FORM
information Worksheet
JOB STREET ADDRESS: I--( (,01-21 •ex-c_I
CITY/STATE/ZIP: ,-)0.,i_v C'I 07,9 PARCEL NUMBER:
OWNER: PHONE NUMBER: G'1 - 5-•? �5
MAILING ADDRESS:
(Street) (City/State) c- (Zip)
CONTRACTOR: ifi I C C' C` R=+1!'a !`� '.�,J C.rr., r,? LICENSE NUMBER: IC-C: �:<C. I %-3 !=' L&
PHONE NUMBER: (15()(-1) 67-2(r•- S' 7 I I
MAILING ADDRESS: '"i31 0 (11k `:J%`.1 C/ C;(!'
(Street) ' (City/State) (gyp)
- MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WC30DSTOYrJIniSER 3 ..: .:; � x 25.00 = 2 y
GAS WATER HEATER x 10.00 =
GASEQUIPMENT<100,000 BTU(INCLUDES : x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
SAS PIPING SEA OUTLET) . -..:.. x 1.00 =
BOQLER/REFRIG 1-100M BTU --_ _- x 12.00 =
3C L IREFR1G 10� �E30tv41 TLI x 20.00 =
BOILER/REFRIG 501-1,000M BTU I x 25.00 =
-
BQ�tR/t"IrFiICa #3301 `i ttt�fi �!# x 35.00 = ..
SOILER/REFRIG+1,750M BTU. - - - - - x 60.00
HEAT PUMP &AIR CONDtmON ER 0-3 TONS x 12.00 _-
4 HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
MEAT PUMP&AIR CONDITIONER 1 30 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS - x 35.00 =
HEAT PUMP u AIR CONDITIONEP+30 TONS x 60.00 =
VENTILATING FANS x 10.00 =
�1I4PORATIVE COOLERS x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYP..E t! HOOD. x 10.00 =
CLOTHES DRYER x 10.00 =
~ NGS....:
;: :...:. � x10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS (NOT;COVERED ELSEWHERE x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED;_GAS APPLIANCE>400000 BTU x100.00=
USED APPLIANCE<400,000 BTU X 50.00
:USED A'PLIANC:E>400 000 BTU _: . x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
AIR HANDLER>10,000;:CFM x 15.00 =
SUBTOTAL $ ,5 6'G
"PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ Som'
SIGNATURE C. ?are.c &I t) 19
Spokane County Division of Buildings
nee.
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