1992, 11-18 Permit App: 92010180 Mechanical Fixtures � l - 1 Ja4 � )�MECHANICAL PERMITAPPLICATION FORM C7-7 ..,- ) CA
i N Uu f\ ' Information Worksheet 1 2-62-
JOB STREET ADDRESS: . I 1 Le O 5 ) 6,-)-- k
CITY/STATE/ZIP: ,J1)`�Y` 1 L-E-1016 o.G1,-, PARCEL NUMBER:
OWNER: YY\-IC,Ii 02-- (7.1--i S c+,PHONE NUMBER: (.Z-CQ - O(p 61
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: ri- I : ( ;-r 1_,>*'-.,,/ .i f F 'Z LICENSE NUMBER: 17---41 IC-0 &&C', 1 i3 b!--k
PHONE NUMBER: /_' C;ril ci‘,2L,--5'`%/ J
MAILING ADDRESS: C • (131 n _`�.7 a 1L(''. ` ')Thr.plio(..i4-).- c11217Cr
(Street) (City/State) (Zip)
._ MECHANICAL WORKSHEET/FEE SCHEDULE
• NUMBER X EACH
DESCRIPTION OF UNITS UNITAMOUNT
ELECTRIC/DUCTWORK(C PARA 1 E SYSTEMS)EMS) ! x 10.00 = _.-.
WOODSTOVE/In SER ! x 25.00 =
GAS WATER HEATER I x 10.00 = l 'DO
GAS.EQUIPMENT00 000 BTU(INCLUD S x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING (EA OUTL } -. .:__ _^ x 1.00 = 3, c7
BOILER/REFRIG 1-100M BTU ---- - x 12.00 = r
BOIL_ R/R:FRIG X01 50M BTU `- x 20.00
BOILER/REFRIG501-1,000i1BTU -.---- ------ x25.00 =
301L ;' EFRIG 1 0002:1.;.-1:750M.BTU :35.00 =
rOfLEPIR'E RIG+1,750M ETU --_ ----- _. ._._- x 60.00 =
.- it S' -9SIO CrNI:ITlO R n. rivS '_- x 12.00 =-
ii EAT P`JMP &AIR CONDITIONER 3-15 TONS ( x 20.00 =
HEAT PWMP&AIR CONDITIONER 1 30 TONS _ x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS- -- x 35.00 =
H SAT PW P 8 AIR CONDITIONER+50 TOMS x 60.00 = -
VENTILATING FANS - -. x 10.00 =
4!nPJILATIVE COOLDRS x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
II HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
: ----> 10.00
GAS LOG 3, x 10.00 = O ,c)(-)MISCELLANEOUS (NOT`COVERED ELSEWHERE x 10.00 --
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
UL!NSTED GAS APPLIANCE 00,000 BTU x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>.W0,000.BTU x100.00=
AIR HANDLER<10,000 CFM x 12.00 =
AIR HANDLER>10,000 CFM x 15.00 =
`' SUBTOTAL $ 13-00
-
., PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT 8dD
FEE DUE = $
SIGNATURE
Spokane County Division of Buildings