1990, 01-03 Permit App: 90000047 Pressure Test MECHANICAL PERMIT APPLICATION FORM /57tow
Information Worksheet
JOB STREET ADDRESS: /" ?/ /V Q(Tj,6":
- /c)
CITY/STATE/ZIP: c � 3� PARCEL NUMBER: 1 ,.�'' .--�
OWNER: f /t/ PHONE NUMBER: / -/-)
MAILING ADDRESS: Svc-: _
(Street) (City/State) (Zip)
CONTRACTOR: C. S )1E6, ,4;(2_,, LICENSE NUMBER: M, 467641-/C/c)//0
PHONE NUMBER:
MAILING ADDRESS: L V/Z5 7721'2
(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 =
HEATING EQUIPMENT <100, 000 BTU x 12 . 00 =
HEATING EQUIPMENT +100, 000 BTU x 15. 00 =
GAS PIPING (EA OUTLET) j x 1. 00 =
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 =
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 $
PLUS: PROCESSING FEE + $ 25 . 00
EQUALS : TOTAL PERMIT
NOTE: MI IM PERMIT FE IS $35. 00 FEE DUE = $
SIGNATURE ei -
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675