1994, 07-25 Permit App: 94007011 AC o `
CHANICAL PE.�MITAPPLICATION FORM Q �®1
VZ'l
(,l -Va. -Id 1 Ls L,5-,B 2- Information Worksheet
JOB STREET ADDRESS: . / 7a g
CITY/STATE/ZIP:S� �,M f PARCEL NUMBER:
OWNER: PHONE NUMBER: S''
MAILING ADDRESS:
,, II (Street) (City/State) (Zip)
CONTRACTOR:/V��t� �� o i_n LICENSE NUMBER:kek 1/A O 7A
i PHONE NUMBER: S J 7 S
MAILING ADDRESS: E -� o S ��,�a,, S in /4,1A.
(Street) r (City/State (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 a
WOODSTOVEt1NS R .:: .... :: x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT 100000 BTU(INCLUDES x 12.00 -
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 -
GAS PIPING (EA OUTL ) x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER1REFRIG 101 ,500M BTU .... • • x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILERIREFRIG 1.;0001-1,750M BTUi x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP&AIR CONDITIONER 0=3 TONS I x 12.00 = /0, 0o
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP & AI R;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 LOG
_ x 10.00 =
MISCELLANEOUS;(NOT COVERED ELSEWHERE ' x 1.0:00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.60 =
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 $ O
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE = $_37,00
SIGNATURE u--
Spokane County Division of Buildings
West 13i 'way Avenue Spokane, WA 99260 (509) 456-3675