1994, 08-03 Permit App: 94007378 AC •
MECHANICAL PERMIT*PPLICATION FORM •
Information Worksheet q i - 137g
JOB STREET ADDRESS: (p 7 0 J I O j
CITY/STATE/ZIP:5p_ 1a-hp 1 L-1)41 �`9 /,°,� . PARCEL NUMBER:
OWNER: .4_44-t, -„ .% PHONE NUMBER: 9<9 - _3.SJ5 /
MAILING ADDRESS:
(Street) (City/State) / (Zip)
CONTRACTOR: /)Th-c--(7 LICENSE NUMBER: A)e R C 0 1-1 4 c) L
/ PHONE NUMBER:
MAILING ADDRESS: E 11%-k 0,02_ t&I f9,
(Street) 0 (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOOdSTOVElINSERT x 25.00 =
GAS WATER HEATER x 10.00 -
GAS EQUIPMENT'dOO.,0(*BtU(INCLUDES x 12.00 = _
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 -
GA x 1.00 -
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REFRIG:'101.,50OM ETU :: .. .. x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
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 1 x 12.00 = JO.
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 ONDITIONER X50 TONS
. ... .. ,: x 60.00 =
VENTILATING FANS X 10.00 =
EVAPORATIVIr GAOLERS 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
_ _......__ . x10.00 =
MISCELLANEOUS(NOT COVERED ELSEWHERE' x 10.00 = •
UNLISTED GAS APPLIANCE<400,000 BTU x 50.110 =
ULINSTED GAS APPLIANCE>400000 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>10000'CFM x 15.00 =
SUBTOTAL $ /.9. 0 0
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$,3 J. 0o
SIGNATURE
Spokane County Division of Buildings
West 131 'way Avenue Spokane, WA 99260 (509) 456-3675