1991, 03-05 Permit App: 91000881 Mechanical Fixtures A_ 2
MECHANICAL P€R!lI1T APPLICATION FORM
Information Worksheet//
JOB STREET ADDRESS: L._.. 3 O 0_S - ( / bv1
CITY/STAT IP: / ! /‘" ,PARCEL NUMBER: /„.) A
OWNER: 0.)1 PHONE NUMBER: 7 L- i' c f 3
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: 11 M Ur'°-7 l 1 '; LICENSE NUMBER: A 14 QUA-4 E l 3 A)
E. n
s,r� Q
S c'ara PHONE NUMBER: ( c, 0 6
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE .
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = 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 BTUilat4` '`%- x 15.00 .= ;0
GAS PIPING (EA OUTLET) r J x 1.00 = 4( o 8
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
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 E 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 r x 10.00 = 10 ‘ 011
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 =
( • , i .�- SUBTOTAL $)4,t430JAAil
fr;)-sk 0 . PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: M ISM PE IT FEE IS $35.00 FEE DUE = $ L-4'03
SIGNATURE
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675