1991, 07-22 Permit App 91004358 ACJOB STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
iV / Lai' .
CITY/ST TE/ZIP: r �/(V atL NUMBER: /e - C&L)'
OWNE ,� n�'' 1 � `��� ��,�I�� vim- g`�S
`��Y" ��L�/vueCX. C( Cy 4414Ti/A4/4PHONE NUMBER: Q% 7_ - c�
MAILING AD T RESS:
0 S6
(City/State) (Zip)
CONTRACTOR: LICENSE NUMBER: /4 L�l�f4F% f 3/0
PHONE NUMBER: ?2 K-e;W .)
MAILING ADDRESS:
(Street)
(Street)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS [TNIT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG.1-100M BTU (NOT A/C.OR.HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TONS _
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)_
UNLISTED GAS APPLIANCE <400,000 BTU_ _
UNLISTED GAS APPLIANCE >400,000 BTU_ _
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
x$?0.00 =
x. 25.00 =
x 10.00.=
x 12.00 =
x 15.00 =
x ,. 1.00=
x 12.00 . =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
= AMOUNT
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $37aD
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675