1989, 11-27 Permit App: 89004922 Furnace5-6
MECHANICAL PERMIT APPLICATION FORM
AfoNation Worksheet
JOB STREET ADDRESS: 50 I S.- C t/ow/ C
y71/3
CITY/STATE/ZIP: 512e7/4Lek. PARCEL NUMBER:
OWNER:
lin Wo/1161-21
MAILING ADDRESS
CONTRACTOR:
(Street)
MAILING ADDRESS: t( 7 (
(Street)
PHONE
G- lia
PHONE NUMBER:
532 el/6 F-,5
5-3 6 F 574 (t):t-46-
(City/State) (Zip)
,Itiry LICENSE NUMBER: 1441-2=-1126-4./2/179/425/
PHONE NUMBER:
/40/ tlyrinu2, 4bQ 5,26N9Y`k-- Ge/ar
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS TWIT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EA OUTLET)
REFRIG 1-100M BTU (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
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 TnNq
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 <10,000 CFM
AIR HANDLER >10,000 CFM
ifc& Of rVAVQ
= 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
)C 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
NOTE: MIN MU PE IT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 37
okane County Department of Building_ and Safety
West 1313 Broadway Avenue Spokane, WA 99260 (509) 456-3675