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1990, 08-29 Permit App: 90004272 Boiler
MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: - / 0 7 / %- 000///-c /1//e - JOB 9%aoE CITY/STATE/ZIP: � ��n//�iy� , /.1.0 PARCEL NUMBER: / t7 O[J4 PHONE NUMBER: ��6 0x'•25 - OWNER: fit/tick- MAILING ADDRESS: ,e5 j9&121= (Street) (City/State) (Zip) CONTRACTOR: 44'z'1W L/m0S-a/z»ICGSTNGLICENSE NUMBER: f1feNtTS/GST/< PHONE NUMBER: 74/7- /fD MAILING ADDRESS: 720 ��X it Xt ilew,'J fi. /dN 9wc/ (City/State) (Zip) (Street), 2 .;MECHANICAL WORKSHEET/FEE SCHEDULE.• NUMBER X EACH 'DESCRIPTION OF UNITS UNIT DUCTWORK SYSTEM WOODSTOVE/INSERT: GAS ,WATER.,HEATER..; , .: _:. - _ HEATING .EQUIPMENT -,<100,'000 ;BTU HEATING .EQUIPMENT +100y.000::BTU,'`= < _ , GAS PIPING "'.(EA OUTLET) _ • _ REFRIG'1-100MrBTU;,(NOT'A/C:rOR51-EAT PUMP).; REFRIGa,1017.500Mrt BTU .': REFRIG 501-1000M BTU k REFRIG:.,l'; 001-1`,<750Mt,B' REFRIG'+1,750M BTU; e`_ HEAT? PUMP& LAIR tCONDITIONER- < 0 3 TONS(; HEAT;PUMP1&'�:AIRaCONDITIONER 3,5515 -;TONS HEAT:'PUMP..&LAIR CONDITIONER ,15 30`TONS ,_. • HEAT PUMP &Y. AIRYCONDITIONER 30=50_'TONS -' HEAT ":-PUMP:':&,.AIR CONDITIONERS+50 TONS'- VENTILATING4FANS ``" EVAPORATIVE',COOLERSA TYPE I>HOOD; (PER 12!4 OR 12.' PTN,cOF HOOD). • CLOTHES.; DRYER ' RANGE:12 GAS S LOG MISCELLANEOUS (NOT COVERED. -ELSEWHERE) - UNLISTED GAS APPLIANCE''<400;000'BTU 1 '. UNLISTED GAS APPLIANCE2) 400; 000 "BTU :.1 USED APPLIANCE .<400, 000 BTU 'g`'''••:. USED APPLIANCE .>400;000`'BTU AIR HANDLER <10;0.00 .CFM - AIR HANDLER >10,000 CFM • NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE SUBTOTAL = 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 5:00.=x 60.00 = x12.0C 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 0.00,..=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 = PLUS:. PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$,32 - Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260______(5.0.9) _456-3075