1992, 12-15 Permit App: 92010943 Mechanical Fixtures MECHANICIL PERMIT APPLICATION FORM 2-- (�C
Information Worksheet
JOB STREET ADDRESS: /= /r3i c' 3 \'d
CITY/STATE/ZIP: 5P / e. L4/&s/71 5y ( PARCEL NUMBER:
OWNER: RON&(W) PHONE NUMBER: 9,2,2 ,2P0 3
MAILING ADDRESS: ,E//3/0 „,2 3 L' S-2O k4,4AL- s
(Street) (City/State) (Zip)
CONTRACTOR: /9 _/ 64 S e rr,i/c e- LICENSE NUMBER:n/G 4 s S a C 9 P
PHONE NUMBER: 3a6-
MAILING ADDRESS: (:t/ 9,2 y / 3140(. .s/,i tel'
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
< «< > <'
x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT<100,000 oTU{INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
a. x 1.00 =
BOILER/REFRIG 1-100M BTU .... x 12.00 =
: x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAL PUMP&AIR CONDITIONEF 0-3 TON$ 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 35.00 =
HEAT`PUM 'All CONDITIt NER+50 TONS x 60.00 =
VENTILATING FANS x 10.00 =
EVAI OI ATI /E OOLERS ._
x10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
x 10.00 =
CLOTHES DRYER x 10.00 =
=
x 10.00
GAS LOG o2 x 10.00 = ()
MISCELLANEOUS(NOT COVERED ELSEWHERi x10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED GAS APPLIANCE40000 'U :>::: >::.;.;::: ':` x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
x100.00=
AIR HANDLER<10,000 CFM 12.00 =
ALaHANDt_Ea1 O,f?OQ+GNt < ::'` [: x 15.00 =
::.......:...::.....::......:..................:..:.:.::..............................................................................
SUBTOTAL $ 20
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE _$ L/x ,00
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675