199, 01-11 Permit App: 93000126 Mechanical Fixtures R i.
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CITY/STATE/ZIP: PARCEL NUMBER:
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OWNER: & '/La ,� .��rn�-�-e,� PHONE NUMBER: /=-12 a'-
MAILING ADDRESS: ,) G' ice. Ci._ -) ,eZ -LA-e---
(Street) (City/State) (Zip)
CONTRACTOR: PSA-r<-coat PekG M - .LICENSE NUMBER: R k+`ZO t+-sk t t Q VT.__
PHONE NUMBER: Oi ,.- 5O c_,
MAILING ADDRESS: a %\au- vv-, ft...s. F aac l 3 •te'�`�^-A \AJ c. Cc 7.ok.
(Street) (Ciy/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATERx 10.00 = JO - 0 O
HEATING EQUIPMENT <100,000 BTU �/ x 12.00 = /3 o
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4.00 =
GAS PIRING (5 OR MORE. EACH: ) -2 - x 1.00 = .Z,Ov
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 HOODS _ 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 $a /' a3
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
MOTs: •, . ' RX T �i $3S.00 FEE DOE _ $ 7` 9
SIGNATURE _/moi ' ' 6 `"'
` Spokane County Deoatboert et NMI h_- -