1991, 03-26 Permit App: 91001327 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: -5 . /3 o S ; I,J r/gib 0^
CITY/STATE/ZIP:3100k0 ,L) Q)f1- . 99(26.6, PARCEL NUMBER:
OWNER: ..S li,i w it )71,"t-e_4 °_ ii PHONE NUMBER: U)-3.2Y gJS'y 7 171-- ,21-/.27j-
MAILING
,21-/-27jMAILING ADDRESS: I
(Street) (City/State) (Zip)
CONTRACTOR: IHIRE VALLEY
LICENSE NUMBER: diel'tJ,4'.� /q/O, '
HEATING & COOLING, INC. PHONE NUMBER: 7€Z c "?
N. 521 ELLA RD..
MAILING ADDRESS: SPOKANE WA 99212
(Street) (City/State) (Zip)
'I
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
'' DESCRIPTION / OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$ 0.00 =
'1 WOODSTOVE/INSERT x 25.00 =
j GAS WATER HEATER / x 10.00 = /0 =°
HEATING EQUIPMENT <100,000 BTU / x 12.00 = 12 °=
HEATING EQUIPMENT +100,000 BTU X 15.00 =
GAS PIPING (EA OUTLET) „2 x 1.00 = o? °..!
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00 =
REFRIG 101-500M BTU x 20.00 =
REFRIG 501-1,000M BTU x 25.00 =
REFRIG 1,001-1,750M BTU x 35.00 =
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 = •
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 =
it
CLOTHES DRYER x 10.00 =
RANGE x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS ' (NOT COVERED ELSEWHERE) x 10.00 =
1 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 $ r2y 00
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE = $ V9 ,00
SIGNATURE /5Y`.Ext iC o,
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675