1991, 05-15 Permit App: 91002605 Mechanical Fixtures -
MECHANICAL PERMIT APPLICATION FORM
Inform tion Worksheet
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JOB STREET ADDRESS: !/6 2 ZZ/I, J,,,,z
CITY/STATE/ZIP: 5,l4, t 4 _ PARCEL NUMBER:
OWNER: 34'c,i ./to e PHONE NUMBER: V2‘ -C.O9 .;:. ._
MAILING ADDRESS:
/ (Street) (City/State) ,/� (Zip)
CONTRACTOR: .1 I.e / i. :,, - LICENSE NUMBER: /""le, f,/ ‘s0/-1' Y
'/ f PHONE NUMBER: q� 3 C C (
MAILING ADDRESS: €& CIC fr/'r 9 /& c)
(Street) City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
W000STOVE/INSERT;.;.. .: x 25.00 =
GAS WATER HEATER::: :::.......................................................................... I x 10.00 = /C0
GAS;EQUIPMENT<100 000 BTU(INCLUDES I x 12.00 = / 2.
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS<PIPING (EA OUTLET) i, x 1.00 = .2
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REFRIG:1 01-500M;BTU ..:.>: - »: x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIG 1 x0001. 1,750M BTQ x 35.00 =
....:...::.:........:...:.:.............::......::.:.....:..........::.::.:::.....:.:.::...................................................
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP &AIR CONDITIONER 0-3 TONS j x 12.00 = / 2.
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP--&:AIR-CONDITIONER 1'5-30-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 COO............„,„..........................................................................:.„<<„,.„.„.„„,,,,.:„.:„.„.,:.,„.„.„.,.:.,.:„.„.„.„.:.:.:.:.:.:.:.„.:.:„:„.:.,,,..„,S 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 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>400000 BTU x100.00=
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER>10000 CFM x 15.00 =
SUBTOTAL $ 3 4 "
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT es,0
FEE DUE _ $ 1
SIGNATURiti /
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675