1991, 07-16 Permit App: 91004236 AC MECHANICAL PERMIT"PAICATION FORM
Information Worksheet ,�/,
JOB STREET ADDRESS: „S f/S G✓6e II(44e ,e,d
CITY/STATE/ZIP: ,.!i9�`r.� PARCEL NUMBER:
OWNER: ! G,1 4+€ PHONE NUMBER: 92 c 3 3 33
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: 'N^)gret LICENSE NUMBER: 1 .4'01,`/,-M` 3"7b'N Y
PHONE NUMBER: S 3�f' / 71/
MAILING ADDRESS: p° Boor (13 / 4 95020z
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTOVEIINSERT :. .. `.;:. ... x 25.00 =
GAS WATER HEATER x 10.00 =
... .............................................................................................................................
GAS EQUIPMENT<100,000;gTU (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/REFRIG:;101-500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILERFREFRIG 1,0001-1,750M BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP & AIR CONDITIONER 0-3 TONS -- x 12.00 = /,2_ so
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 TON S 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 LOG x 10.00 =
MISCELLANEOUS (NOT COVEREDELSEWHERE, • x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED 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 $
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE = $ 437-`"
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675