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1990, 07-23 Permit App: 90003447 AC MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS(: ( : / ( ( / - 7 (IL's /e' isa;L72 CITY/STATE/ZIP: ,A,✓l. al/fl. /90FARCEL NUMBER: OWNER:• a'&Q = / PHONE NUMBER: _ e 7,, _ �j /, Q5 7 MAILING ADDRESS: 4 • U / T l r ( 1 /4/ - 05 (Street) (City/State) (Zip) CONTRACTOR: ;. L; kJ f")L�Ii9 L/LICENSE NUMBER: AE- /934 / E. PHONE NUMBER: 9� 8--,2/66 MAILING ADDRESS: (Street) ` (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS ITNIT = AMOUNT DUCTWORK SYSTEM x$10. 00 = WOODSTOVE/INSERT x 25.00 = GAS WATER HEATER x 10. 00 = HEATING EQUIPMENT <100, 000 BTU x 12. 00 = HEATING EQUIPMENT +100, 000 BTU x 15. 00 = GAS PIPING (EA OUTLET) x 1.00 = REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12. 00 = REFRIG 101-500M BTU x 20.00 = REFRIG 501-1, 000M BTU x 25. 00 = REFRIG 1, 001-1,750M BTU x 35. 00 = REFRIG +1,750M BTU x 60. 00 = HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ / x 12 . 00 = / , ()Q 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 = 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 $ J .00 PLUS: PROCESSING FEE + $ 25. 00 EQUALS: TOTAL PERMIT *7 NOTE: MINIMUM PERMIT FEE IS $35. 00 FEE DUE = $ J� /. 0 0 SIGNATURE Spokane County Department of Building_ and Safety West 1303 Broadway Avenue Spokane, WA 9260 (5U9) 456-3675