1991, 10-18 Permit App: 91006986 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
Information Worksheet Li' } fs j 1
JOB STREET ADDRESS: �• I ,.. d I °+ ~(
CITY/STATE/ZIP: ),� "4'1 f ad.) L a,, '11' :r PARCEL NUMBER: 'a-- `7 D' S
OWNER: .* 'I C,‹ .E. f s k i , .,+ t.-ecr+ PHONE NUMBER: �� .tt-. t
MAILING ADDRESS: E, I?a ,1 I . 15 4 irl f'' I.
n (Street) (City/State) (Zip)
�1
CONTRACTOR: c j o f L ii 4 LICENSE NUMBER:
�J 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 =
............................................................................... ....... ..............................................
................................................................................ .......................................................
x2 =
GAS WATER HEATERx 10.00 = jp, 0G,
GAS EQUIPMENT<100 000 BTU(INCLUDES x 12.00 = / .c o
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING(EA OUTLET`)::.... .*i x 1.00 = . co
BOILER/REFRIG 1-100M BTU x 12.00 =
BOIL /IEFRIG:l0i-5OOM BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
Bt?ILER/REFRIG 1,0001 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 =
x2 .00 =
:liE�►'�'>�'�;MP: 'AI[�.: t1Nflt�`I�t�ER>:l5E1;TANS.:::::``' ::::::: 5
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP&AIR CONDITIONER+50 TON.S 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... ::.. x10.00 =
CLOTHES DRYER x 10.00 =
RANGE ; :: . ::::` x 10.00 =
GAS LOG I x 10.00 = ,/0.00
MISCELLANEOUS(NOT COVERED ELSEWHE ;RE x 10.00 =
UNLISTED GAS APPLIANCE<4_00,000 BTU x 50.00 =
ULINSTEDGASAPPLIANCE>400,000 BTl x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>4Q0,000 DT0 : : x100.00 =
AIR HANDLER<10,000 CFM x 12.00 =
AIR HANDLER>1.O,000:;CFM. x 15.00 =
SUBTOTAL $ J7,00
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ t',0. ,
SIGNATURE t ., ..). 4 ,- 3 L_
Spokane County Division of Buildings .
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675