1991, 04-11 Permit App: 91001765 Range, Piping MECHANICAL PERMIT APPLICATION FORM
/ Information Worksheet
!
JOB STREET ADDRESS: $ 7 1 /0
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: '7W--tide PHONE NUMBER: S-3q d ro/
MAILING ADDRESS:
(Street) Q__I (City/State) (Zip)
CONTRACTOR: � f� //1-GI®/f. LICENSE
NUMBER: a-C) cd 5ge „2949 C`J'
PHONE NU ER: 53,x- 6-94a,/MAILING ADDRESS: 55 c9 y / ,LP "r'P '179.2/7-
(Street)
17l2/Z(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 =
GASrEQUIPMENT 100 000 BTU(INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS;;PIPING(EA OUTLET) x 1.00
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REI=RIG 101-500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/I >=FRIG: F0041-1,750M BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
.
HEAT PUMP&Ai1 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 =
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 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYPE II HOOD x10.00 =
CLOTHES DRYER x 10.00 =
x 10.00 =
RANGE
GAS LOG x 10.00 =
MISCELLANEOUS(NOT COVERED ELSEWHERE x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED GAS APPLIANCE X400,000 BTt1 x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
..:.:::.:.
x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
A1R;HANDI_ER1 ,QOO OFM x 15.00 =
SUBTOTAL $ /r,40C'
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT DL
FEE DUE =$
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675