1992, 10-23 Permit App 92009270 Htg EquipMECHANICAL PERMIT. APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: C"'/0.5 J -ocrQ'y
CITY/STATE/ZIP: S;Oo4Q,, e 6:9, Ul PARCEL
NUMBER:
OWNER: /P Ttv-ey mot, �c/, v6?y7 PHONE NUMBER: %r7 - 7�o2
MAILING ADDRESS:✓ %///c,c,r-21a c ,r2 Sj
,q� e' Z--t.9e 979`-C
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
MAILING ADDRESS:
PHONE NUMBER:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT'
GAS WATER HEATER
GAS EQUIPMENT' «00 000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS,PIPING (EA;OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101500K/I: BTV1.
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,00W1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP &AIR CONDITIONER'0-3,TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAr PUMP & AIR CONDITIONER 15-30. TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TON r
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' FTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RAN:
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE >400;000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400000"BTU •
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000`.0
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
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 12.00 =
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 =
x1o.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675