1993, 03-19 Permit App: 93001641 Mechanical Fixtures /Lo 35q• 2 gab voT Z I N - ��0I
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Q t��Lp , '. nECHANICAL PERMIT APPLICAT oRM O F 93
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L -FI '' IB Information Worksheet
JOB STREET ADDRESS: .C) A. - a- a I ` 3 • v
CITY/STATE/ IP: i1 A . •1 e, �' PARCEL NUMBER:
OWNER: 1 C1., Le.(' A I PHONE NUMBER: 9
_. , ' 37 /'
MAILING ADDRESS: .
(Street) (City/State) (Zip)
CONTRACTOR: (' G�t�r'x
LICENSE NUMBER: /l.�'�lcc//i1/7C 'I? 7
� PHONE NUMBER: ,G31..1_ (075--
MAILING ADDRESS: 6. ,5/03 I QLc i' `‘79., )
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTOVE/INSERT x 25.00 = _
GAS WATER HEATER x 10.00 = /1 0
GAS EQUIPMENT�c100,000 •
ETU{INCLUpES ; , . �i x 12.00 =
I� CO
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTLET) ... ..... . : :::.. .-.4 _ x 1.00 = , , co
BOILER/REFRIG 1-100M BTU x 12.00 =
BQILER/;REFRIG 101.>500M;BTU : '.>. . x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIG 10001 1,750M ETU ; )� x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP &AIA CONDITIONER:O 3 TONS ;; ;: x 12.00 = j,�, o
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP&;AIR CONDITIONER::15 30 TONS ..... x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP&;AIR C;ONDITI,ONER +50 TONS x 60.00 =
VENTILATING FANS x 10.00 =
EVAPON.ATIVECOOL"ERS < ;; x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYPE II HOOD <... .. x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE _ * x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS(NOT COVERED ELSEWHERE x 1,0.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.100 =
ULINSTED GASAPPLIANCE>400 0000 ETU 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 $ , n. (e)
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT /
FEE DUE =$ L2
e SIGNATUREG4- V
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675