1989, 12-08 Permit App: 89005125 Mechanical FixturesMECHANICAL PERMIT AP''LICATION FORM
Information Wo:` -sheet
JOB STREET ADDRESS: NO/4X-d- -79 - / °f i), - ' £D.
500kPck N Vi,`{ PARCEL NUMBER:
Oh) ykii,rJ(5o(i
CITY/STATE/ZIP:
OWNER:
PHONE NUMBER:
MAILING ADDRESS: %V 3'2.(61 () 1,
(Street)
CONTRACTOR:
12,-ONA&T- -4J
ip,
MAILING ADDRESS: e 7A-14 0'
(Street)
5 pO rtJi-i JP/A-
/
(City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
1)4wt Nt, 1-"A-
(City/State) (Zip)
MECHANICAL
DESCRIPTION
WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
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 TONS
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
= 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
/G
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE /(5_75.4,e_.171-- 9 ' C /
West 1303kBroadwav AvenuertSpokane, WAS 99260 Safety
(5 9) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE