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1990, 03-12 Permit Application: 90000842 Gas FurnaceMECHANICAL PERMIT APPLICATION FORM Information Worksheet � JOB STREET ADDRESS: N `t' © I ( CITY /STATE /ZIP: OWNER: MAILING ADDRESS: PARCEL NUMBER: PHONE NUMBER: et 2 2_ ') Cl Z (Street) CONTRACTOR : ` tJ (City /State) (Zip) ICENSE NUMBER: /L/V (/0 iS 2 Q2-2_ --s-u- (Zip) qcr .20v PHONE NUMBER: MAI LING ADDRESS: £ l L o v 2 (Street) (Cit /State) MECHANICAL WORKSHEET /FEE SCHEDULE NUMBER X EACH OF UNITS UNIT DESCRIPTION DUCTWORK SYSTEM WOODSTOVE /INSERT GAS WATER HEATER HEATING EQUIPMENT <100,000 BTU HEATING EQUIPMENT +100,000 BTU GAS PIPING (1 - 4 OUTLETS) GAS PIING (5 OR MORE. EACH:) 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: MINIM P� S $35.00 SIGNATURE Spokane Countv Department of BFai{ dint and Safety = AMOUNT x$10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = 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 = SUBTOTAL $ l-Z "-) PLUS: PROCESSING FEE EQUALS: TOTAL PERMIT FEE DUE + $ 25.00 STTF ADORFSS: N 440P ADAMS RD PRDJFCT NtJMRFR: 90000842 PFRMIT HSF: GAS FURNACE nFsrPipTinN PFRMIT TYPES: ME INSPECTOR FuRNACF FTNAt FORRY, JEFF OCKEY, REED DATE 05/24/90 07/13/90 RESULT APPROVED APPROVED