1992, 05-13 Permit App: 92003384 Mechanical Fixtures MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: G /7 -
CITY/STATE/ZIP: .5 o' o kph Gc�i 5 1 PARCEL NUMBER: c
OWNER: 7(15-h r eA7 72 e_ PHONE NUMBER: 2-�'?/2- /
MAILING ADDRESS: ! /a7//. - 2 `/ /(,+4n, e S'7*.c4 G
(Street) (City/State) ,,��//// (Zip)
CONTRACTOR: (11411 e 5 ero s. /I/C LICENSE NUMBER: <J ^/111E; �O2 FP
J PHONE NUMBER:2 -Vs--3 /9'7 /C. /Z1‘ a,d327
MAILING ADDRESS:%/ of 2-'V fVE /// t!1 5 r/C/.x0H./�r.4 78033
(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 = ‘1.9 . o 0
x 12.00 = t2 .
GAS EQUIPMENT+100,000 BTU DUCTWORK) I x 15.00 =
7 TIi=
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 =
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 =
x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TY.P..E.I I.HOO ...............
x 10.00 =
CLOTHES DRYER:.:.::.............................................................._........_..........._ I x 10.00 = \a - U
x 1 00
. 0 = rad ) �
. _.
.......................................................................................::.::.................. .
GAS LOG x 10.00 =
MISCELLANEOUS(NOT COVERRED ELSEWHERE x 10.00 = ! ) ,;"
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINS E GAS ADPL IANI E>400 00 BTU x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>4 Q 000 BTU x100.00 =
AIR HANDLER<10,000 CFM x 12.00 =
AIR;HANDLER 10,000 CFM x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$
SIGNATURE / )2'12 /
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Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675