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1991, 10-14 Permit App: 91006792 Furnace, Piping
MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: /}.. '730 a 5 / CITY/STATE/ZIP: <>i/'ri i,„, r--. , L 4 - PARCEL NUMBER: T-7 iIf2. tens OWNER: 54-\.(.- Lk., G( PHONE NUMBER: MAILING ADDRESS: 54-,--1 SMITH HEAT(eet) CONTRACTOR: E. 1r' N',0-00‘ SP0„ ,r.,. 'rA 99207 (. ':) 328-4431 MAILING ADDRESS: WAYNESH258A4J (City/State) LICENSE NUMBER: PHONE NUMBER: (Zip) (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) tiff:. >><><<>><>><>< GAS WATER HEATER GAS t Q:UIPMPNT 1Op GAS EQUIPMENT +100,000 BTU DUCTWORK) • BOILER/REFRIG 1-100M BTU B: ILERl BFtil" ]:: ;:::. M:B:• BOILER/REFRIG 501-1,000M BTU BOI ER/I E RIG 1 0001::-1:,75.0.M BOILER/REFRIG +1,750M BTU HBAT PisJ P - <AtR CO DITIONER: 0-3 TONS->`< HEAT PUMP & AIR CONDITIONER 3-15 TONS •HEAT PUtvtP & AfR C• 7ND T1O E1 15 O TONS'>> HEAT PUMP & AIR CONDITIONER 30-50 TONS ::HEAT P •MP &AIRO t 1T) • VENTILATING FANS • TYPE I HOOD (PER :12' OR 12' PTN..OF HOOD) • CLO'T'HES DRYER UNLISTED GAS APPLIANCE <400,000 BTU aTtr USED APPLIANCE <400,000 BTU :>US<4Pf'I:ii!.1.GE<E''U<>><>»>»<<> <?€ AIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE / (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x12.00= x 15.00 = x1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x35.00 = x.60.00 = x 10.00= x10.00 = x-.50.00. - x10.00 = .. .x10.00,=- •x 10.00= x 10:00 = x10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = !?°C" - • . ' . ..: . • .. .. : . . : • - • . • SUBTOTAL $ I `/ °7' PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE �i ° v = $ -,/ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675