1991, 07-10 Permit App: 91004097 Range, Pipingu�
MECHANICAL PERMIT APPLIhTION FORM
Information Worksheet
JOB STREET ADDRESS: .3q 11'
CITY/STATE/ZIP: SlAn 1drin'1 0tS2.DI, PARCEL NUMBER: g25/t/-
OWNER: --)\014 \X;.rrn PHONE NUMBER: Q1V - crri��n4F
MAILING ADDRESS: Ictq ao
(Street) 3cj l\ sId6oAmmq (Ci y/State) (Zip)
CONTRACTOR: \. i rvct �w,Z tion LICENSE NUMBER: 4;1,11t'Ya.4.CVilnt
PHONE NUMBER: -2-f,S a
MAILING ADDRESS: a- 3,7 Av-P ) Wim. 'tV03
(Street) (C'ty/State)_ (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
x$10.00
x 25.00
x 10.00
x 12.00
x 15.00
x 4.00
x 1.00
x 12.00
x 20.00
x 25.00
x 35.00
x 60.00
x 12.00
x 20.00
x 25.00
x 35.00
x 60.00
x 10.00
x 10.00
x 50.00
x 10.00
x 10.00
x 10.00
x 10.00
x 10.00
x 50.00
x100..00
x 50.00
x100.00
x 12.00
x 15.00
oo
, o0
Flea- 16.%.(H. To ;Ls
NOT
SIGNATU
INIMUMMPE T FEE IS $35.00
sabuRn
SUBTOTAL
$ lb.°0
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Apo -
Spokane un
Spokane?unty Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675