1992, 05-04 Permit App: 92003048 Furnace, PipingMECHANICAL PERMIT APPLICATION FORM
Inforfiiation
JOB STREET ADDRESS : 2 - / / J. --e
GIVE/STATE/ZIP: 6-0061 r ,-e (4A 95;206
OWNER: il,6A x 8%.o0
Worksheet
PARCEL NUMBER:
ofp
PHONE NUMBER: 9 2/ .7 66 7
MAILING ADDRESS: --////906 Ao0Xl e ..c4/ l,)e GtIf1. 6
(Street)
CONTRACTOR: 4,f H (5 /le/1 f .mss
4d_
MAILING ADDRESS: g -7//3 0 cv Pte,
(City/State) (Zip)
LICENSE NUMBER: Z:7 ,15)/457 ?/A.it/-
PHONE NUMBER: -171',“: rj'6A2g
�d cjiall-fAxey L24, 4749:a.43
(City/State) (Zip)
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS ITNIT
.DESCRIPTION
DUCTWORK SYSTEM
WOODSTOyE/INSERT
GAS WATER HEATER
'HEATING.EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING . (EA - OUTLET)
REFRIG" :1-100M BTU. (NOT A/C OR HEAT" PUMP)
REFRIG'101-500M BTU .
REFRIG_501-1;000M BTU•-
REFRIG.,1,00l-1,750M"BTU
REFRIG+1,750M BTU
HEAT. PUMP &
HEAT PUMP &
HEAT "PUMP &
HEAT.PUMP &
HEAT PUMP &
VENTILATING.
EVAPORATIVE
*AIR CONDITIONER 0-3 TONS _
AIR. CONDITIONER.3-15 TONS
AIR CONDITIONER 15-30 TONS
AIR:CONDITIONER 30-50.TONS
AIR CONDITIONER +50 TONS _
FANS .. "
COOLERS
TYPE I' HOOD (PER 12' OR 12' PTN. OF MOOD)
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 <16,000 CFM
AIR HANDLER >10,000 CFM
= AMOUNT
x$10.00 .=
x 25.00
x 10.00 =
x 12.00.=
x 15.00 =
x 1.0Q.=
x 12.00 =
x 20.00 =
x 25.00 =-
x
x 35.00 =
x60.00 =
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 =
/
•
•
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
•
SUBTOTAL
PLUS: PROCESSING PEE
v. .
EQUALS: TOTAL PERMIT
FEE DUE
$ /3
+ $ 25.00
= s 3 $'i
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675