1991, 02-21 Permit App: 91000652 Furnace, Piping!4ZCHAk.{7:'>ii, `c1-e="S%ViU ttC')F �uu matiuiu ruan�\m
SOLt1 K 4' 1.1T , Information Worksheet "
Vie: ElvuEs : ILI I /o I
3 B STREET ADDRESS: $• /l O t 3 0 w D/ S W II
CITY/STATE/ZIP: SPoKf1�1C1 WA. 99aOGPARCEL NUMBER: ZIP) /1/ - ilei
PHONE NUMBER: Ia 6 -8 4-1 .5 6
/v3 S/ Sia4)1ca„a LJ. a 991R/5((City/State) (Zip)
MerTALLICENSE NUMBER: AdOEflp/ /SP Nz-
PHONE NUMBER: y$'8 O %6 a
99x/6
(City/State) . (Zip)'
-t52-
OWNER: X/4,1 SC NOEA)
MAILING ADDRESS: (2, 0, QOX
(Street)
CONTRACTOR: /9NDEtS aA' S SNEe T
MAILING ADDRESS: S, /37o3 TRENT Viak/Wil til A -
(Street)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
' OF UNITS UNIT
DESCRIPTION
DUCTWORK SYSTEM
w
WOODSTOVE/INSERT
.-GAS WATER HEATER
HEATING EQUIPMENT <100,000
',HEATING .EQUIPMENT +100,000
GAS'PIPING (EA OUTLET)
REFRIG4-100M.STU (NOT A/C OR HEAT PUMP)
;REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
BTU
BTU
WHEAT 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'
TYPE II HOOD
CLOTHES DRYER
PTN. OF HOOD)
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 <10,0.00 CFM
.;":;AIR''=HANDLER">10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
1 .a44
= 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 60.00 =
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 15.09 =
SUBTOTAL
/g; as
/, co
$ /6•so
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Spokane. County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675