1992, 11-02 Permit App: 92009627 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
•' Inform tion Worksheet
JOB STREET ADDRESS: E_ / -
22
CITYiSTATE/ZIP: in a k✓4--- PARCEL NUMBER: 1\MM.
OWNER: !` wu,� ,(Q�r v� ��, PHONE NUMBER: ) - 7 _-
MAILING ADDRESS:
SMITH IMEMING (City/State) (Zip)
CONTRACTOR: E 102N0R1 LICENSE NUMBER:
SPOKANE.WA 99207
(509)328-4431 PHONE NUMBER:
MAILING ADDRESS: WAYNESH258NJ
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER 4 x 10.00 = l 0 .°'/
GAS EQUIPMENT<100,000 BTU (INCLUDES / x 12.00 = t Z
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTLET) x 1.00 = a- e
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REFRIG 101-500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x25.00 =
BOILER/REFRIG 1,0001-1,750M BTU x 35.00 =
BOILER/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 =
ULINSTED 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 $ `-) L1 `a"/
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTAL PERMIT
FEE DUE = $ / 7 ,
SIGNATURE '%�4� ��: �� '/
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675