1992, 09-22 Permit App: 92007919 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
Iaforrnaiion Worksheet J''! +
JOB STREET ADDRESS: /0q07 E. I t' B I L �,
CITY/STATE/ZIP: b'Ct vC 99 ,20k:, PARCEL NUMBER: 45'21e, /I
OWNER: ktin 1-t PHONE NUMBER: qc.c? - /V 78
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: F I C C, (7/4ietE/J C E,.l v2 LICENSE NUMBER: 4 I C.0 6/C_,i%3 b LA
PHONE NUMBER: (_5(7'qs-. &'- %1 /
MAILING ADDRESS: E • '131 n JP K'a�1-C E, ` E i.-'t=,1,,,(,_ )-�-): 992 '(c
(Street) (City/State) (Zip)
._ MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTOVE1IiJSERT ,;s,<.::::.::::::::::#:n,::::: tEES:::.::.:::,:: x 25.00 =
GAS WATER HEATER ' x 10.00 = /b . CD
GAS:EQUIPMENT<100 00O BTU:(INCLUIDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING(EA OUTLET) " i'`` V''" r - x 1.00 = �.CO
. BOILER/REFRIG 1-100M BTU ---- - - x 12.00 =
BO1tgR/REFf. 101 500M :<•._::.:::..>_ib , �><. _
BOILER/REFRIG 501-1,000M BTU ------- ----•---- x 25.00 =
fBOILER/REFRIG 1- 00
fl1-175OM :€�v '~ x 35.00 = _
BOILER/P.EFRIG +1,750M BTU `-... ---•--------•------ x 60.00 = -
Hr.:AT:PUMP & AIR.CONDITIONER O•- TONS x 12.00 = - --
HEAT PUMP &AIR CONDITIONER 3-15 TONS • x 20.00 =
.HEAT PUMP &AIR CONDITIONER 15-30 TOt'S `a ? a x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS • x 35.00 =
hEATPUMP'&AIR:CONDITIONEP -50 TONS »:l 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:HOOMERRIVIMEGOINNEMIRMS x 10.00 =
CLOTHES DRYER x 10.00 =
:RANGE. ::.,.::::,;,
>_:> x 10.00 _
GAS LOG x 10.00 =
MISCELLANEOUS (NOT COVEREDE SEWHERE r'3"`? `</ 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 <> ax100.00=
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER>10,000.CFM . x 15.00 =
`'' SUBTOTAL $ 02-2 .O
•-PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT �7 00
FEE DUE _ $
SIGNATURE
Spokane County Division of Buildings C. el-4