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1991, 06-18 Permit App: 91003404 Furnace, PipingJOB STREET ADDRESS: CITY/STATE/ZIP: OWNER: MAILING ADD S : MECHANICAL PERMIT APPLICATION FORM Information 133tO CONTRACTOR: MAILING ADDRESS: Worksheet. '41.; • CEL NUMBER: PHONE NUMBER: (Street) (City/State) (Zip) LICENSE NUMBER: /girioo91-/- /93.0 PHONE NUMBER: 9ag--.7/00 (Street) (City/State) (Zip) MECHANICAL DESCRIPTION WORKSHE T/FEE SCHEDULE NUMBER OF UNITS DUCTWORK SYSTEM WOODSTOVE/INSERT, GAS WATER HEATER HEATING EQUIPMENT.<100,000 BTU HEATING EQUIPMENT +100,000.BW. GAS PIPINGAEA,OUTLETy REFRIG:1-100M BTU (NOT A/C. OR,HEATI)UMP) REFRIG 101-500M BTU REFRIG 501-1,000M BTU REFRIG 1,001-1,750M BTU REFRIG +1,750M BTU HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & VENTILATING AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER FANS 0-3 TONS 3-15 TONS 15-30 TONS 30-50 TONS. +50 TONS 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 <16,000 CFM AIR HANDLER >10,000 CFM XufgH 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,6000 = 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 = = AMOUNT ,2.40 02 ,00 NOTE: SIGNATURE SUBTOTAL PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 3?" Spokane County Department of Building_ and Sa West 1303 Broadway Avenue Spokane, WA 99260 456-3675