1993, 02-01 Permit App: 93000542 Range r J
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet _ �.
JOB STREET ADDRESS: S E-2'2-
CITY/STATE/ZIP: .5d0o ,-c- X14. 99-11G, PARCEL NUMBER:
OWNER: •-SaL I mo,V ti'/mort1 PHONE NUMBER: - 9.22 3 7 a 3
MAILING ADDRESS: - 5 Spe• '` u' ';. 97-1/6
/ (Street) (City/State) (Zip)
CONTRACTOR: � -t � c� LICENSE NUMBER: 6AJE5- " OYI m
/PHONE NUMBER: � ? � 7 � Z
MAILING ADDRESS: /o�G -��j��'� M`y Z&- / Z6, 9 Q I
(Street) V (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
x 25.00 =
GAS WATER HEATER x 10.00 =
SAS EQUIPMENT <100,000 S'IU(INCLUDES [:: _ x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
x 1.00 =
BOILER/REFRIG 1-100M BTU _ x 12.00 =
2 .00 =
80ILEC�IREI=1�fa a01-5C�OM 3TU........ ': .<:>:`::; .::':`>:::`::>'::: . x 0
BOILER/REFRIG 501-1,000M BTU x 25.00 =
x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
x 12.00 =
HAAT SUMP�AIR�CJNt�I'CICyNEFl 0-3.TONS ```' :::.:`'
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEATPIJMP;vAIRGO.NDITIONER 15 30 TpN25.00 S :>:: x =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP&AIR CONDITIONER+50 TONS ' :'. x 60.00 =
VENTILATING FANS x 10.00 =
IVE L��i
x 10.00 =::::::::::::::::::::::::::::::::::::::.................... ..........................
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
x 10.00 =
.... -_
CLOTHES DRYER x10.00 =
•RANGE
x 10.00
GAS LOG x 10.00 =
MISCELLANEOUS(NUT COVERED ELSEWHEIR <>`' : : ` x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED GAS APPLIANCE>40(Y000 BTU '<><' :` < " _ x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
AI R H ND;I R>10,000 CFM..:: x 15.00 =
SUBTOTAL $ /° '-'
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
- cin
FEE DUE =$ 3C _
SIGNATURD_7) +
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675