1991, 08-15 Permit App 91004765 ACJOB STREET ADDRESS: / • �L-3 -
"ECHANICAL PERMIT APPLICATION FORM
Information, W,orksheet
c()Leet/wt,(.:
CITY/STATE/ZIP: / t2J4 ?f1 PARCEL NUMBER:
OWNER:
MAILING ADDRESS:
CONTRACTOR:
PHONE NUMBER: 2F-5-93 f
(Street)
C
Spokane; WW+?sM;ngto.„ 99216
MAILING ADDRESS:
(City/State) (Zip)
LICENSE NUMBER: AMQUAHE193N1
PHONE NUMBER:
(Street)
978-2100
(City/State)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
NUMBER X EACH
OF UNITS UNIT
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 &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
EVAPORATIVE
AIR CONDITIONER 0-3 TONS _
AIR CONDITIONER 3-15 TONS
AIR CONDITIONER 15-30 TONS
AIR CONDITIONER 30-50 TONS
AIR CONDITIONER +50 TONS _
FANS
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 <16,000 CFM
AIR HANDLER >10,000 CFM
rNOTE: MINIMUM RMI FEE IS $35.00
IGNATURE
SUBTOTAL
x$10.00 =
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 12.0C
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
+ $ 25.00
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675