1991, 09-18 Permit App: 91005983 Mechanical Fixtures MECHANICAL PERMIT APPUCATION FORM /- /3
Information Worksheet
JOB eTREET DRESS 19M 3 - E (IL ‘Ye%tlae42.7
CITY/STATFr. f/ZIP: - 1ti� PARCEL NUMBER: ? Syy^ / /.�
5
OWNER: PHONE NUMBER:
MAILING ADDRESS: 2:7 Z,i�-- S -- ��__ hsurht-Q 9
(Street) (City/State) (Zip)
CONTRACTOR:F6MTON S Q- ILL c LICENSE NUMBER: 14-recyir --44o (1-7
PHONE NUMBER:
MAILING ADDRESS: LLB t '1c�n..w..�..•¢'�5� 3
(Street) 0 (City/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 HEATER x 10.00 =
HEATING EQUIPMENT <100,000 BTU x 12.00 =
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4.00
GAS PIRING (5 OR MORE. EACH: ) x 1.00 =
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 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 $ I3�°
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT^
NOTE: M NIMUM P REIT FEE I8 $35.00 FEE DUE = $ 3
SIGNATURE i..
Spokane County Department of Building and Safety