1992, 11-18 Permit App: 92010189 Insert, Piping MECHANICAL PERMIT APPLICATION FORMI b\
Information Worksheet
JOB STREET ADDRESS: 7 r /C j( 7 (i W..ele CJO4/ 212 0.0
CITY/STATE/ZIP: ,. " rj4,e (i. 4 99-2 /r>2 PARCEL NUMBER:
OWN ER:= ./PE_S Es/eN PHONE NUMBER:.h J i- 4/9
MAILING ADDRESS: 0 ,1/Z/'
(Stregt) (City/State) (Zip) •
CONTRACTOR: ./-?f GP,%i.- t O/V C:,TS LICENSE NUMBER: L,/ SGP//0d
(� PHONE NUMBER:�O t ).62(0 -E-P26/
MAILING ADDRESS: PC )‘ D.1/0-if 61h 994g6.
(Cityt tate) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
INOOISTOVEIINSEIT x 25.00 =
GAS WATER HEATER:.;:.:;.:.;:............ .................................. .......... . x 10.00 =
G S EQUIPM N <100,t 'U INCLUDES <:`> '` x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
�; S.�.P�N�.( ouTLE�.. .. ....... ........ ...... .... . .. ...:. : j x 1.00 = CO
BOILER/REFRIG 1-100M BTU x 12.00 =
x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIG 1,0001 1, '50M ETU' `:.: >: x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HE TPUMP AI CONDITIONS=R 0 TONS ..:`: x 12.00 =
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 CONDITIONER+50 TONS <:.'' x 60.00 =
VENTILATING FANS x 10.00 =
YAP V`'01�
x 10.00 =
..............:.
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
x 10.00
CLOTHES DRYER x 10.00 =
x 10.00
.. ....................................:>:.;>:.:>;;:.>::.>.... .. .....
GAS LOG ::.. :.: x 10.00 =
MISCELLANEOUS(NOT COV
: ERED •ELSEWHER x 10.00 = f 2, 66
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED GAS APPLIANCE>400,000 STU x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
ED:: <pPL
x100.00=
1AN t=.�t
-
AIR HANDLER<10,000 CFM x 12.00 =
;Al>�
x 15.00
SUBTOTAL $ 400
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ j&.06
SIGNATURE Q6i9a.""'-
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675