1992, 08-03 Permit App: 92005991 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM r..
Information Worksheet
JOB STREET ADDRESS: E. 9807
CITY/STATE/ZIP: PARCEL NUMBER: z
OWNER: 116V71 hi, PHONE NUMBER: 0q5?-/A7/
MAILING ADDRESS:
(Street) (City/State) (Zip) 1
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CONTRACTOR: 'l.trQ, t vi-04-"(--. c&-.LICENSE NUMBER: 14rg 1T-14- t to 6-z_..
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• PHONE NUMBER:
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MAILING ADDRESS: F-L( cr (C-, 14,,,,,___47,0.1)4 , � i�-�G..... � cz Zc_4, ,
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION I OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATERx 10.00 = /D d"'
HEATING EQUIPMENT <100,000 BTU / x 12.00 = / ? od
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4.00
GAS PIVING (5 OR MORE. EACH:) a x 1.00 = Ree)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00 = '
REFRIG 101-500M BTU x 20.00 = 7.
REFRIG 501-1,000M BTU x 25.00 =
REFRIG 1,001-1,750M BTU x 35.00 = 1
REFRIG +1,750M BTU x 60.00 =
HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ x 12.00 = y
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 = i
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 $ A 7• as
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT^ �/�j
NOTE: liTNI -PE I IS $35.00 1 FEE DUE = $ 17i a
SIGNATURE % /�"
Spokane County Department of Building and Safety _ _