1991, 09-17 Permit App: 91005965 Heater, Piping MECHANCALfERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: //O c_ 6,*722 4 1/4.-
CITY/STATE/ZIP: SP�X�S f c��, j, 19 le PARCEL NUMBER:
OWNER: ,E✓E 2 -7'r L , JA g;/E FL- PHONE NUMBER: (Is(--17 -z-z y
MAILING ADDRESS: E
(Street) (City/State) (Zip)
CONTRACTOR: LY LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
QDSTt3Vi=11NSERT ;.:: x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT<100 0 I TU(INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
�.:::�PILING >rrA Ol1Ttr
x1.00 =
. ..... ....
. ....... . :::: .:.
BOILER/REFRIG 1-100M BTU x 12.00 =
QiLER/R FI IG„ 01 M BTI x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIG1 x0007 1,750M BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
T PUMP I AIR CONDITIONER 0 TANS x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
IlleAreumglomprOONINTIoNgails4g3pN%imegio x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
x 60.00 =
VENTILATING FANS x 10.00 =
.:
APORATIVEiC3LERS ... x 10.00 =
TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD) x 50.00 =
CLOTHES DRYERx 10.00 =
x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS(NOT COVERED ELSEWHERE ';:.:''`„ x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTiGAS.APPLIANCE>400,t RTLJ `>:`:' >:. > ' x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
AIR CANDLER 1 ,000 AFM
x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$
SIGNATURE . , • «�•
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675