1992, 12-03 Permit App: 92010596 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM ��2-L �5(-) o
Information Worksheet
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JOB STREET ADDRESS: � e-77777),i ��'(� c' ( /'L��
CITY/STATE/ IP:\. ep) (A A 2(f /C0 PARCEL NUMBER:
OWNER: (,J )0i ('7 PHONE NUMBER: ,,,,(-/-(2,36--L7
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR22/ZC/'I � a/.;22 LICENSE NUMBER:/ti'2CC)f//2i 70e
PHONE NUMBER: CJ_
MAILING ADDRESS: �� _/0 l/L )z/ �, �, 2201) ,9Z/e
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOObSTOVE/INSE iT.. : x 25.00 =
GAS WATER HEATER:::.:............... .........._........ .............. ................... x 10.00 = /6,(
.............................................................................
AD
GAS EQUIPMENT 11?0,0 8TU(INCLUDES �, x 12.00 = /).
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING'(EA OUTIET�.. ... .. : x 1.00 a ch
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REF.RIG 101 ;500M:BTU ;.;; x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BO..R..ERI.REFRIG 1,00 1 1,750M STU ... 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 =
NEAT PUMP 8�AIR CONDI 'IONER``15-3 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
NEAT PUMP.&`AIR CONDITIONER>+50.TONS x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE< OO ERS x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
..... .....................................................................................................................................
TYPE I(HOOD`> x 10.00 =
....... ................ ............. ........ . ............................................ ...............................
CLOTHES DRYER x 10.00 =
RANGI~
x 10.00 =
GAS LOG x 10.00 =
MISCELt ANEOUS (N T COVERED ELS WHEI E.......:: x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.10 =
ULINSTED GAS'APPI IANCE.>400 000 BTU x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANC >400,000 BTU !` x100.00 =
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER>10,00.0 CFM.I x 15.00 =
SUBTOTAL $ c)6/ 0
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE _ $ L �, ZP)
SIGNATURE '-� �✓" �_`��___
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675