1994, 09-16 Permit App 94009110 Mech FixturesMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
- . r
JOB STREET
CITYISTATE/ZIP: o %cr2 xf 0e
OWNER:)_ v Y ct < zc
PARCEL NUMBER:
PHONE NUMBER: 7 % � - I
MAILING ADDRESS:
1 / / (Street) (City/State) (Zlp)
CONTRACTOR: Ila�`z„ 1�1. 11 ni LICENSE NUMBER:X1 PLr r161
/,, PHONE NUMBER:
MAILING ADDRESS:-, _`;
c-
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVEIINSER7 ,
GAS WATER HEATER
GAS EQUIPMENT <10Q000`tdTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILERIREFRIG 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1.,,0001-1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 1's-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 11 HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400.000 BTU
ULINSTED GAS APPLIANCE X400,000 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 ,_� I__�''
Pp)
NUMBER
OF UNITS
X EACH
UNIT
-AMOUNT
T-1 =
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 1.0.00 -
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
i
/
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 0?
Spokane County Division of Buildings
West 131 'way Avenue Spokane, WA 99260 (509) 456-3675