1993, 01-19 Permit App: 93000266 Mechanical Fixtures nlECIIAN1CAL A1'PLACA'lUUN FORM v
Information Worksheet
JOB STREET ADDRESS: -/Cf G' g
CITY/STATE/ZIP: 512orp, /')/1 )c'� PARCEL NUMBER: 1.-/ D-Pil, %) c'
OWNER: f2 c' 13 //CA P PHONE NUMBER: j ,Y
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: MARTIN SHEET METAL inc. LICENSE NUMBER: MARTISM170KW
PHONE NUMBER: 924-8088
MAILING ADDRESS: BLDG. #103 SPOKANE INDUSTRIAL PARK SPOKANE, WASHINGTON 99216
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) _ x$10. 00 =
WOODSTOVE/INSERT x 25. 00 =
GAS WATER HEATER / x 10. 00 = JU L'
GAS EQUIPMENT <1000, 000 BTU_ (INCLUDES _ / x 12 . 00 = / & O
GAS EQUIPMENT +1000, 000 BTU_ _DUCTWORK) x 15. 00 =
GAS PIPING (EA OUTLET) x 1.00 =
BOILER/REFRIG 1-100M BTU x 12 . 00 =
BOILER/REFRIG 101-500M BTU x 20. 00 =
BOILER/REFRIG 501-1, 000M BTU x 25. 00 =
BOILER/REFRIG 1, 001-1, 750M BTU x 35.00 =
BOILER/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 COOLERS _ _ x 10. 00 =
TYPE I HOOD (PER 12T OR 12 'TPTN. 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 $ t/0c
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FE IS $35. 00 FEE DUE _ $ 7/�
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Spokane County Department of Buildings
Nest 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675