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1991, 02-21 Permit App: 91000654 AC
MECHANICAL PERMIT APPLICATION FORM Informatir- Worksheet JOB STREET ADDRESS: • // M /�v' CITY/STATE/ZIP: 49o/((t'zLG(i,•` c19)/6 PARCEL NUMBER: OWNER: PHONE NUMBER: 9a7-- /72 MAILING ADDRESS: _ (Street) (City/State) (Zip) CONTRACTOR: ,/, j/g6Cf,1 hL76. /eve, LICENSE NUMBER: ,4/, / t/6,// PHONE NUMBER: 9 CC/, MAILING ADDRESS: /it -j/y /671- 4©k aid • 99>7/-2- (Street) /-2-(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 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 = / • O U 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. 1-50 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 $ /0Q,0 ) PLUS: PROCESSING FEE + $ 25. 00 EQUALS : TOTAL PERMIT NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE = $ •-�'�' a� SIGNATURE Spokane County Department of Building_ and Safety West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675