1992, 08-10 Permit App: 92006231 Mechanical Fixtures ` 1,45-331- I 0 5� MECHANICAL PERMIT APPLICATION FORM
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JOB STREET ADDRESS: „ //7 / c�hn
CITY/STATE/ZIP: / - A 04 , PARCEL NUMBER: i\
OWNER: /,(Y7/ /1)71/ /7 ! PHONE NUMBER: 90WV "r
MAILING ADDRESS: //V/ (..5 /4<"---l / G/.2% W k
(Street) - (City/State) (Zip) . I
CONTRACTOR: gfl v4,NS ' A-s. .s-t1/4r&,L ..L.-.4., LICENSE NUMBER: Perridzyt, - lit, S L.
PHONE NUMBER: 0LZ"t_-'SU v O
MAILING ADDRESS: \l E3 L.L. 'v-,Mt-v. s,f %-e<.a! la' -n VC -,_r Co
(Street) ( y/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25.00 = 'l
GAS WATER HEATER x 10.00 =
HEATING EQUIPMENT <100,000 BTU / x 12.00 = /2 .()0
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 = 7. Oct
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00 = s
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 3010.00 =
EVAPORATIVE COOLERS x 10.00 =
TYPE I HOOD (PER 12' OR 12, PTN. OF HOOD) xI50.00 =
TYPE II HOOD x 10.00 = a
i.
CLOTHES DRYER x 10.00 = ;y
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 $ /3"
PLUS: PROCESSING FEE + $ 25.00
^
EQUALS: TOTAL PERMIT
NOTE: NI: - RMI FEE IS $35.00 FEE DUE = $ �goo
SIGNATURE r
4R I
Spokane County Department of Building and Safety
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