1994, 11-03 Permit App: 94011031 Mechanical Fixtures •
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet ott.1 ,1103 I
JOB STREET ADDRESS: Lt 3 I rt:
CITY/STATE/ZIP: .5.P4,e oort PARCEL NUMBER:
OWNER: tic/}Mc! PHONE NUMBER: w� -0 �!- '7O2
MAILING ADDRESS: 'fo3f ' r
(Street) (City/State) ,�»,� (Zi )
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CONTRACTOR: .+9 -i / "'C 4* LICENSE NUMBER: 31%Se1C VM.1O���1
PHONE NUMBER:
MAILING ADDRESS: 6 4; .51k ,t 1
(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 • x 10.00 =
GAS EQUIPMENT<100,000 BTU (INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTLET) x 1.00 = /,6,0
BOILER/REFRIG 1-100M BTU x 12.00 = J?,po
BOILER/REFRIG;101-500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIG.;1,0001-1750M BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
•
HEAT PUMP &AIR CONDITIONER 0-3 TONS x_12.00 = /2,
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 $ 2S:°d
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT SC).
FEE DUE =$
SIGNATURE -- zeg.ora
Spokane County Division of Buildings