1991, 03-21 Permit App: 91001249 Furnace, AC, Piping,JOB STREET AAbDRESS
CITY/STATE/ZIP:
OWNER:
MECHANICAL PERMIT APCATION FORM
Information Worksheet
4024 PARCEL,NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: 'fmS LICENSE NWiB : Per'14 4i\ tth4 1 / v ic3Z�
PHONE NUMBER: ' 2- — O c]
PHONE NUMBER:
' IS -13 '1
MAILING. AbDRESS': GALS (,jo
;(Street)
(City/State
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION OF ITS UNIT
(Zip)
=AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIING (5 OR MORE. EACH:)
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 & AIR CONDITIONER:0-_ 3_ TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR `CONDITIONER '15-30 TONS
HEAT PUMP & AIR CONDITIONS 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 'TONS
VENTILATING 'FANS
EVAPORATIVE c9insis-. a —
TYPE I HOOD :-(PER;'.'12 !
TYPE II HOOD
CLOTHES "DRYER
RANGE_
GAS LOG^vow
_
MISCEL LANEODU (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
MOTE: MIN ERMIT FEE S $35.00
SIGNATURE
Spokane County Department of Building . and Safety
SUBTOTAL
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 4.00 =
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 =
11:S0,00=
.`
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 =
I "'Lye.,
l
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ S"e