1994, 08-10 Permit App: 94007658 Mechanical Fixtures . if 7-1-9--1 2.-2--3 MECHANICAL PERMIT APPLICATION FORM •
6-lcut ililli{ Z Information Worksheet 14-_-7(„aF tl Bz , s---E
JOB STREET ADDRESS: J // G l c�
CITY/STATE ZIP:S � ,�Q , / , 0 L PARCEL NUMBER:
OWNER: I�,� �- PHONE NUMBER: 7 g-7 �.?-V
MAILING ADDRES: 01
(Street) (City/State) ,� (zip)
CONTRACTOR:/Up -i-l) / ,-AZ.° LICENSE NUMBER: A)0/? (n EA 0 -7 (e 4 /
a'r / PHONE NUMBER:
MAILING ADDRESS: /O 7 -1 - i' ,s-4_, 79-5)1
(Street) (Ci /State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTOVE./1NSER' x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT:<100)000 STU•(INCLUDES 1 x 12.00 = /�9.0 0
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 -
GAS;PIPING.(EA OUTL ..... .;:.. . . x 1.00 -
BOILER/REFRIG 1-100M BTU x 12.00 -
BOILER/REFRIG 101 .0.0M BTU ; x 20.00 =
BOILER/REFRIG.501-1,000M BTU x 25.00 =
BOILER/REFRIG 1,0001-'1,750M BTUi' x 35.00 in
BOILER/REFRIG +1,750M BTUx 60.00 =
HEATPUM.P&AIRip)oplitoN ER 0-3 TONS _/ x 12.00 = �. n U
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT;PUMP.&AIR`CONDITIONER 1540 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT:PUMP`&AIR CONDITIONER +50 TONS
x60.00 =
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 50.1)0 = -'
ULINSTED GAS APPLIANCE>400, 0 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 $ (y OD
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
�� f� �-- FEE DUE = $ Y9 DL'
SIGNATURE _ Lam_ _
Spokane County Division of Buildings
West 131 'way Avenue Spokane, WA 99260 (509) 456-3675