1991, 11-26 Permit App: 91008200 Furnace, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: t\-1 . &1---\
CITY/STATE/ZIP:3-7*----4-1,..\ E-_--17-_ PARCEL NUMBER: I Q./. -.?0e) ad
OWNER: PHONE i\--2 '12 I,. T\---- ---. C5Tr- PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: R & R HEATING & A/C, INC. LICENSE NUMBER: RRHEAA*1 06BW
PHONE NUMBER: 484-1 40 5
E. 1723 Francis Spokane
(Street) (City/State)
MAILING ADDRESS:
DESCRIPTION
WA 99207
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +1 00,000 BTU DUCTWORK)
:WWWW*WWWX*MiWift*M!
MaggigatMEMOMMN
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BO RE
§; )z"..):4)
CONDITIONER 1 TONS,
STIN
HEAMP,UMP., :JR;CONDONER 3050 TONS
• T .
VEN NG :F
CLO
r.
D (F?ER:
2' OR 12' PTN. OF HOOD)
veki
'DRYER:a:?;i;;..; • -
GAS L
UNUSTED GAS APPUANCE <400,000 BTU
•
'
•
USED APPUANCE <400,000 BTU
AIR HANDLER <10,000 CFM
•
Aftlq
•• • •••;)•:•:•••:::)$$$::::::::
•••
• ,••••• • • • • • • • • .• •
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
x 25.00 =
x10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x25.00 =
x 35.00 =
x 60.00
x12.00
x 20 :00: =
, . , .,;•I.lat".P.
''x'25.
x 35.00 =4-,
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 '.=
x 10.00 =
x10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x50.00 =
x100.00 =
x 12.00 =
x 15.00 =
t
\ • W
SUBTOTAL
$ i'3.CC
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ 58 .Ce
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675