1992, 10-30 Permit App: 92009593 Mechanical Fixtures MECHANICAL P;cRMII APPLICATION FORM
Information Worksheet
/
JOB STREET ADDRESS: C7 :A 100C 44',u_ vo e d -
CITY/STATE/ZIP: C 0()I�"`\`` e( LU ra PARCEL NUMBER:
OWNER: e.ri gt'1 tO U i C PHONE NUMBER: CIL 2(4 ` -
MAILING ADDRESS: HoLc.=HZ.a-�3-1J
(Stree+t) ( (City/State) (Zip)
CONTRACTOR: 1 t t V A 1'4-T LICENSE NUMBER: LI-01..k1 <!' (2 ',en
PHONE NUMBER: `b 3S-1
MAILING ADDRESS: ---� �.G�2 �' C vO - C '�`'CS W �c'�& er
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER / x 10.00 = / 040c)
HEATING EQUIPMENT <100,000 BTU x 12.00 = i2 0 0
HEATING EQUIPMENT +100, 000 BTU x 15.00 = -0.459
GAS PIPING (EA OUTLET) X- x 1.00 = 2, 0
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 = /g.c v
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 LOG x 10.00 =
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 $ 36 .00
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT !;
NOTE: TMUM PERMIT/F/E IS $35.00 FEE DUE = $ Gl/y`06
SIGNATURE � -` '
7
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675