1994, 04-28 Permit App: 94003661 Furnace, Pipingi
MECI IANICAL PEflMI%APPLICA1ION FOf1N1
(` Information Worksheet
JOB STREET ADDRESS: ' � A Z.,. Cr . /S00/1-0_-) 7 i
CITY/STATE/ZIP: kart e t 9 i. PARCEL NUMBER:
OWNER: %' r / ( i<' b
MAILING ADDRESS: $--1-;\ C4, (, .
t30 0 v' -Q
(Street)
CONTRACTOR: •' 44 4.5 1e( -QCAf" itn
MAILING ADDRESS:'P.O , (30 % (1 t O'
(Street)
DESCRIPTION
PHONE NUMBER: C/SV"-9'3(a
.sr)Kt\ vve , Ls claat ia,
(City/State) (Zip)
LICENSE NUMBER: W T TI-IC.13 I C N _,
PHONE NUMBER:
(City/Slate)
MECIIANICAL WORKS! IEET/FEE SCI IEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
`GAS:EQUiPMEt
:: "...�...f.',..
GAS EQUIPMENT +100,000 BTU DUCTWORK)
:E .CIE1 '
BOILER/REFRIG 1-100M BTU
1:4<;:1 ::k. 0ivt :S'
BOILER/REFRIG 501-1,000M BTU
RML r .1EFf1fr i )oo i ; : mmo�t
BOILER/REFRIG +1,750M BTU
1 DA:..:,:t1Ni : '<AI ::c t1D.1,I. .::..:..y::.;...::..
,
HEAT PUMP & AIR CONDITIONER 3-15 TONS
Ht Af:puP1p:>:& )IrI:• ONDW:i'WONE.'>>'S
HEAT PUMP & AIR CONDITIONER 30-50 TONS
UMP AICA :: I.1 i''
VENTILATING FANS
A
I?..RA..:vr
B..
TYPE I HOOD (PER 12' OR 12' PTN. OF 11000) •
CLOTHES DRYER
GAS LOG
LI N q S:(t.Qt COVE ED;ELSEWIIEF
z
UNLISTED GAS APPLIANCE <400,000 BTU
Ui:;i.N.$ 'i i : $ GAA:P:i LIS NQE y4
USED APPLIANCE <400,000' BTU
USED,APPi IA 1,0.E<:>4Qo�0oo>U: > }
AIR HANDLER <10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
9Ciat l
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
_ ,
/
x10.00 =
x12.00=,
x 15.00 =
x1.00 e
x 12.00 =
x20.00 =
x25.00 I
x35.00=
x60.00
x12.00 d
x 20.00 =
x25.00 =
x 35.00 =
x 60.00 = ,
x 10.00 =
x 10.00 in
x50.00 =
x10.00 b
x10.00 =
x 10.00 =
x 10.00 =
x 10.00 d
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x12.00 =
x 15.00 =
IO-O0
J,ot)
•
SUBTOTAL
$ //.OG
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT"
FEE DUE
_ $ 1(40.60
Spokane County Division of Buildings
est 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675,
•
•