1992, 08-25 Permit App: 92006846 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: E. /As-"a /e2 T
CITY/STATE/ZIP: U -eta t�G 1�( [i✓� '7037 PARCEL NUMBER:
OWNER:. 0.4 k��� � .,. PHONE NUMBER: 9.4,c2-,0_1,, 'Z
MAILING ADDRESS: ,s7 e -
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
..........
x 25.00 =
GAS WATER HEATER / x 10.00 =
x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
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 =
HEAT PUMP All iC tNt ITIONER.0:. TONS x 12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT�U1utP AtI�+ �'3�1D1TI�NEI� 1:5:.Ott TANS:> > ':'> ;;
x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP&AIrt CC3KIL11TIONEft+50 TpNB ``. x 60.00 =
VENTILATING FANS x 10.00 =
x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYfE II H44D..,.... x 10.00 =
CLOTHES DRYER x 10.00 =
0
Ra
x 1 .00 =
GAS LOG x 10.00 =
MISCELLANEOUS(NOT COVEREI ELS WHERE;: x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED SAS APPLIANCE>400,010 11 :::° : :: :'' .:: 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$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675