1995, 04-07 Permit App: 95002091 Mechanical Fixtures MECHANICAL_P.RMIT APPLICATION FORM 9Information Worksheet
c�
JOB STREET ADDRESS: ! 7/. hi
CITY/STATE/ZIP:-5e4, Acr;,-.r 14r4 , 9irc)0 4, PARCEL NUMBER:
OWNER: -.11►,0 �,, ,i f PHONE NUMBER: f .V -- '91)4-Ji/
MAILING ADDRESS)
(Street) (City/State) (Zip)
CONTRACTOR: DY`cLICENSE NUMBER: A A 4
PHONE NUMBER: _1.:3)-)/ - )/ 7 S'
3MAILING ADDRESS: �i 10 / s �_ S Ell�,`.'"-nia tL/at.. f
(Street) v (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
Iht00. .STO...ELi.NS1tl '.:::•.; <<<><:»>>:>»::<;,.>;:: ::>>>::>::: :>:;..:..::..;::.::::.>:::::;::>::>
x 25.00 =
..........................................................................................................................
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT gi0O,t 00.BTU{INCLUDE ;. ''`: «:; : :; x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
IPI
x 1.00 =
BOILER/REFRIG 1-100M BTU`:.;;;::.:........................................................ x 12.00 =
x 20.00 =
....::::::............
BOILER/REFRIG 501-1,000M BTU x 25.00 =
x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HAAT PUMP&AIR CONDITION R 0 3 TONS;:;;;: / x 12.00 = / f�
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
HEAD PUMP&Alit Cts NbFrIONER 15 30 Tt NS :: x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
_ H A `PUMP&Atli CONDITION R+50 TONS > x 60.00 =
VENTILATING FANS x 10.00 =
E.
x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYR < •
..........
................... ..
x10.00
= •
CLOTHES DRYER:;.;:.;:.::................... . ............................................................. x 10.00 =
:.:�........ ...::<:.;::.;::;:;.;;:. ......... x 10.00 =
GAS LOG x 10.00 =
...:.:.:.:::.
MISCELLAN OUS(Nf T OV RED ELSEWH R '<> x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTUx 56.10 =
... ...........
UI�INSTED GAS APPLIANC >400, 0 BTU `'> : ` '`:`< x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$, ' 2 o
SIGNATURE ?7,7, -(7-C2--„, �
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675