1991, 11-12 Permit App: 91007757 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:/O C// //l2G i.v1,cl CT,
CITY/STATE/ZIP: 5 Pe.C.4 PARCEL NUMBER: , 'X 3
OWNER: PHONE NUMBER: ?2. to � ?
MAILING ADDRESS: .a.9 ‘// ;13�" ' /c/v 99
(Street) (City/State)68r - (Zip)
CONTRACTOR: �G-�/ C-LL i4 Cn LICENSE NUMBER:
PHONE NUMBER: /�
MAILING ADDRESS:
(Street) (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 =
GAS EQUIPMENT<100,000 I TU(INCLUDES:::,..;::. x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
ii0BOILER/REFRIG ipoo ... mooti $TES.......... aggisi....... ......... x 35.00
BOILER/REFRIG +1,750M BTU x 60.00 =
ifigN :Pl,l:.._,Ef&AIR COf+1DfTf ONER -43'9[4S .....-::::;::,:;::;:: x 12.00
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP&AIII CONDITION Ri IS-3E rdNS::::::-:; '::> ::: x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
'T PUMP&AIR CONDITf ONER+50 TONS:>_:::_,.:;.:;;;:>::::>. .: x 60.00
VENTILATING FANS x 10.00 =
x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
x 10.00 =
CLOTHES DRYER x 10.00 =
xl =
GAS LOG / x 10.00 =
MISCELLANEOUS(NOTCOVERED LSEWHE#RE ` i x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
x100.00=
USED APPLIANCE D <400,000 BTUx 50.00 =<<><> >> <> <>> > > >
x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00 •
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE = $
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675