1991, 08-21 Permit App: 91005173 ACMECHANICAL PERMIT ¥PLICATION FORM
Inforratitn Worksheet
JOB STREET ADDRESS: F_ C. 565 q TM
CITY/STATE/ZIP:
Saar fl G1 Z PARCEL NUMBER:
OWNER:JEFF i CAROL (-AR-5C7J PHONE NUMBER: 553.4- 1039
MAILING ADDRESS: E . 6565 q SR.6CANE_ U./4 att2.12.
(Street)�vN(City/State) (Zip)
j
CONTRACTOR:DIVC SJES2&V QJ'JT{2CX_ LICENSE NUMBER: Dt VCOEC LERL ,
PHONE NUMBER:
MAILING ADDRESS: tJ• 7(5 r4L7pq
(Street)
S!ar044Q L 1.64 94.7202--
(City/State)
C7702.(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
= AMOUNT
DUCTWORK SYSTEM
47OODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIRING (5 OR MORE. EACH:)
REFRIG 1 -loots DTV (NOT A/C OR HEAT PUMP)
REFRIG 101-500E BTU"
REFRIG 501-1,00614 ETU
REFRIG 1,001-1,c750M `BTU
REFRIG +1, 75f:M (t _ _
L 0-3 TON
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
HEAT PUMP & AIR CONpiTIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
COOLERS •
TYPE I HOOD (PER 12' OR
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
EVAPORATIVE
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
12' PTN. OF HOOD)
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
!c 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
l2.
NOTE: Nj27IHUM�P REIT E IS $35.00
SIGNATURE 04/41 �Jy
Spokane ounty Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 ._
2
SUBTOTAL
$ 12 °U
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
. FEE DUE