1990, 08-17 Permit App: 90004004 Furnace, Piping. Z t 4 ei cr.' Vii' vflt"- c�•�V
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
6 "2, ,/
JOB STREET ADDRESS: /1/ - i 42-0 Ce N ' e r /?ej
CITY/STATE/ZIP:
OWNER: 67-2 17/.1
Sfo (4.1-4 PARCEL NUMBER:
q/)--/7-
6
yy.77G tie 1471-21 PHONE NUMBER: 9.2 G- 6 7 5-7,5
MAILING ADDRESS:
CONTRACTOR:
MAILING ADDRESS:
IV-; CO Govt/Cr Red _Soo KQNC
(Street) (City/State)
LICENSE NUMBER:
PHONE NUMBER:
(Street)
(Zip)
(City/State) (Zip)
MECHANICAL
DESCRIPTION
WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UTNIT
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
12.00
15.00
1.00
12.00
20.00
25.00
35.00
60.00
12.0C
20.00
25.00
35.00
60.00
10.00
10.00
50.00
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
/v7
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
.7
8 0d,
= $
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 9260 (5 9) 456-3675