1991, 02-26 Permit App: 91000715 Mechanical Fixtures •
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: P-7- / )S / 7 - �//� L
/i- i/5"
CITY/STATE/ZIP. ,/10_ ._%4,„ i W 6 ' CEL NUMBER:
OWNER: E / ' / ,4t `� 4''Wi ONE NUMBER: 7;i -
MAILING ADDRESS: 6-AA/14-C, -
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER: 4 M PV/419/, /934-}/
PHONE NUMBER: 7p�Z 1T---,./Q
MAILING ADDRESS:
(Street) (City/State) (Zip)
1
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 = 1,
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 =
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 12 ' OR 12' PTN. OF HOOD) x 50.00 =
TYPE II HOOD x 10.00 =
CLOTHES DR ER _ _ x 10.00 =
RANGE_ _ GL:jJ0 _ t-Vyl �� (i7�C l _ _ t x 10.00 = (D . D a
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 $ /( o
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: M PERMIT/ EE IS $35. 00 FEE DUE = $ 4 '0 d
SIGNATURE P/ /
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675