1989, 10-11 Permit App: 89003838 Mechanical Fixtures . MECHANICAL PERMIt AP_,PL ICATION FORM f(9"6j
r In± oration Worksheet
JOB STREET ADDRESS: /(/ , 4:1 / Z U--C 0„
('-, CITY/STATE/ZIP: S-cDcrk ,,N, �;� A PARCEL NUMBER: /55///-C)5/5
0 OWNER: ,1 E (Z RLI , i N.5 U PHONE NUMBER:
MAILING ADDRESS: GU 41/2_ LjA,p i c
LO (Street) (City/State) (Zip)
CONTRACTOR: �a 1(3 \i, _ _-...v-- Q. m LICENSE NUMBER: R(_?)-} P $ Pe-q 6 7
PHONE NUMBER: "f-/(a 7 " n6 -i-/
MAILING ADDRESS: CU I j p K 6-4, S c/ �c,�� �V� / Co
(Street) (City/St � A ate) (Zip)
vi
Z MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM J x$10. 00 = 10 • (J O
WOODSTOVE/INSERT x 25. 00 =
c GAS WATER HEATER x 10. 00 =
HEATING EQUIPMENT <100, 000 BTU I x 12 . 00 = (..7 . c-c-`
HEATING EQUIPMENT +100, 000 $,TU _ x 15. 00 =
GAS PIPING (1 - 4 OUTLETS) _ Lf ( _ f x 4 . 00 = 4 , 6-6
GAS PIVING (5 OR MORE. EACH: ) x 1. 00 =
1y REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12. 00 =
REFRIG 101-500M BTU x 20. 00 =
k REFRIG 501-1, 000M BTU x 25.00 =
z REFRIG 1, 001-1,750M BTU x 35. 00 =
Q 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 15-30 TONS _ x 25. 00 =
UJ HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35. 00 =
> HEAT PUMP & AIR CONDITIONER +50 TONS _ x 60. 00 =
VENTILATING FANS x 10. 00 =
EVAPORATIVE COOLERS x 10. 00 =
U TYPE I HOOD (PER 12 ' OP 12 ' PTN. OF HOOD) x 50. 00 =
}/ TYPE II HOOD x 10. 00 =
CLOTHES DRYER x 10. 00 =
RANGE x 10. 00 =
O GAS LOG x 10. 00 =
- -MISCELLANEOUS (NOT COVERED ELSEWHERE) _ x 10. 00 =
UNLISTED GAS APPLIANCE <400, 000 BTU_ _ _ x 50. 00 =
\i] UNLISTED GAS APPLIANCE >400, 000 BTU_ _ _ x100. 00 =
> USED APPLIANCE <400, 000 BTU x 50. 00 =
USED APPLIANCE >400, 000 BTU x100. 00 =
AIR HANDLER <10, 000 CFM x 12 . 00 =
AIR HANDLER >10, 000 CFM x 15. 00 =
SUBTOTAL $ ,E v
PLUS: PROCESSING FEE + $ 25. 00
?
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE = $ e, T
SIGNATURE /444
0
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675