1995, 07-06 Permit App: 95004993 Mechanical Fixtures � SZ3� . 23c�II L/7 o -
/ / MECHANICAL PL'RilllT-APPLICATION FORM
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Y�-i& LQ41r� ,4 Information Worksheet
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O3 STREET ADDRESS: �l , 1 51.2.. tiA f
CITY/STATE/ZIP: Qe CCi jet `e (AM Teo-3/ PARCEL NUMBER:
OWNER: ! c/, 9JJ ( 1 /1)e Ato02 PHONE NUMBER: 7-`p2 6,-6 c/6 7
MAILING ADDRESS: ;16-W41
(Street) (City/State) /� (Zip)
CONTRACTOR: Ci vtai, ''tip 16)TR.C ; Tw e- LICENSENUMBER: ac'�11A u I'1/-� 077 Kl"
PHONE NUMBER: Ey 7 yo.3 2_
MAILING ADDRESS: A(./ /.�`J ' r1/or +ck t 141e&j to/
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM -x$10.00
WOODSTOV/INSERT x 25.00 =
GAS WATER :HEATER x 10.00 = /0,06
HEATING EQUIPMENT <100,000 BTU x12.00 =
HEATING -EQUIPMENT"+100,000 BTU x 15.00 =
GAS..PIPING ;(EA :OUTLET) 3 x 1.00 = 3, B 6
REFRIG1-100M;BTU``(NOTA/C OR HEAT PUMP) x 12.00
REFRIG 101-500M`•BTU x 20.00
REFRIG501-1,000M >BTU x 25.00 =
REFRIG .1,001-1,750MBTU x 35.00
REFRIG':+1,750M .BTU x 60.00 =-
HEAT PUMP
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 =
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 x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE x 10.00 =
GAS _ ire pTa .2 x 10.00 = „24,1!90
MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ x 10.00 =
UNLISTED GAS APPLIANCE <400,000 BTU _ _ x 50.00 =
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 $ 3�, ^;c)
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT
NOTE: MIIMUM PERMIT FEE IS $35.00 FEE DUE = $ ;CC;
SIGNATURE 4
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane. WA 9260 (509) 456-3675