1992, 09-24 Permit App: 92008034 Furnace, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: Al. 2 `IP d✓u
CITY/STATE/ZIP: S K -e--, ilif1, f?.2/)_.. PARCEL NUMBER: •-5JKLf• o2-2--
OWNER: 1A.¢ ell/W PHONE NUMBER: 92 y • kr, Y6
MAILING ADDRESS: N...2.1110 dna
(Street)
CONTRACTOR: O•
W4 •
(City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER: 9�
MAILING ADDRESS: N- . WO 8.
J
.}.- o I L (Street
1/vtAci -e C%(,tt c u, MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
:+:.+r:::.+..vr.
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
tai
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
UNLISTED GAS APPLIANCE <400,000 BTU
V j.V V,u a
USED APPLIANCE <400,000 BTU
IIS C <Apl'LIAt
AIR HANDLER <10,000 CFM
I OL
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
w4 _
(City/State)
9.9-1 i.2,
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= 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 15.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675