1992, 10-21 Permit App: 92009172 Mechanical Fixtures - MECHANICAL PERMIT APPLICATION FORM i,y2_,1 v Y n Z
Information Worksheet I ���
JOB STREET ADDRESS: , `IDO( - \ X .
((' 'E (
CITY/STATE/ZI104N\ , ----)C.: PARCEL NUMBER:
OWNER: -C.: . �CN& f\c \ PHONE NUMBER: CA(.0 , C-1.(0.--
MAILING ADDRESS: co.. mt-N,
(Street) (City/State) (Zip)
CONTRACTO� � r� C) LICENSE NUMBERl�1l` I ��c'' Q ���
PHONE NUMBER: t 0 - p,'\° 1
MAILING ADDRESS: ' '-).j� \ \.c•- t.0-Y\ � 4141 `eCet
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(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOOD$TOVE/INSERT x 25.00 =
GAS WATER HEATER x 10.00 =
GAS.EQUIPME.N `<100,000 B `U(INCLUDES 1 x 12.00 = 1 Q -CDC)
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING(EA OUT Er) iB .' .>:> x too = l. 00
BOILER/REFRIG 1-100M BTU x 12.00 =
BOIL REFRIG..101- M.B' ><> `>5? : < :<: : : x 20.00 =
BOILER/REFRIG 501-1,000M BTU ` ' 'x 25.00 =
BOILER/REFRIG 1,0001<-1,750M BTU> '' : ;';: ;:.�..; x 35.00 =
BOILER/REFRIG +1,750M BTU 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 1.5-- 30 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEATPLIMP&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 =
TYPOIt 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 =
ULINSTED GAS APPLIANCE>400,000 BTU x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>400,000 BT1J . . x100.00 =
AIR HANDLER<10,000 CFM x 12.00 =
AIR HANDLER>10,000(CFM x 15.00 =
SUBTOTAL $ 1 .eX)
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE = $ ,OO
SIGNATUR
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675