1989, 07-28 Permit App: 89002491 Furnace, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: ' -4/22 &//2/474q 642
CITY/STATE/ZIP: p �1
OWNER:
(.moo (1/2(94).4_
MAILING ADDRESS: 5- 7/D 60 Q`/p,i? 62c1>
(Street)
PARCEL
NUMBER:
PHONE NUMBER:
CONTRACTOR:
MAILING
6-.1-42_-€110c, ala .
(City/State) (Zip)
7 j / L / Li/o f-/ LICENSE NUMBER: 71----/.447//7--L
t4IP_ Oat
� r ") PHONE NUMBER: q2.--V----erD/�
ADDRESS: F. % / %')Y fig7/6/-ri-ei€7106 $Po /La -7-K_ w4 9 q last<
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE
DESCRIPTION
S CHE DULE
NUMBER X EACH
OF UNITS UNIT
= AMOUNT
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 11 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
I
x$10.00 =
x 25.00
x 10.00 =
x 12.00 =
x 15.00
x 4.00
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 =
f9 •�'o
/9
,rf•�D
NOTE: NI',e!'E • IT F E 18 $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ S�
Spo''ne ounty Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675