1991, 01-24 Permit App: 91000250 Furnace, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: // 4//c' cJ
CITY/STATE/ZIP: 5pe kari t (,) a. '90106 PARCEL NUMBER:
OWNER: GX 1 IIc . %,,Go rtAtei
MAILING ADDRESS: .5 -rn
CONTRACTOR:
PHONE NUMBER: 702 2. -047 2. lo
(Street)
quit. l 11. 1
MAILING ADDRESS:
pcD,Isox C69‘.0
(Street)
(City/State) (Zip)
LICENSE NUMBER: Q }A HA 13G )c -x
PHONE NUMBER: 1-71 Go 7' Vo 3 )-
/44Iwo r
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT
DUCTWORK SYSTEM _
WOODSTO'jE/INSERT
GAS WATER HEATER _ _ _ _ _
HEATING -EQUIPMENT"_ <100,000.BTU
HEATING EQUIPMENT +100,000_. BTU
GAS PIPING :;'(EAS OUTLET) _
REFRIG '1 r,100M :"BTU ?(NOT A/C OR_ HEAT'
REFRIG:;-101-500MBTQ
REFRIG 1501-1,000M ;BTU _ _
REFRIG ..1001-1,750MBTU
REFRIG +1,750M BTU
HEAT' : PUMP '& AIR'`.CONDITIONER
HEAT PUMP & AIR`CONDITIONER
HEAT PUMP :: & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
VENTILATING FANS
0-3= TONS _
3 -15 -TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPEII HOOD (PER 12' OR 12'
TYPE II HOOD
CLOTHES DRYER
RANGE
PTN. OF HOOD)
GAS LOG
MISCELLANEOUS (NOT COVERED E
UNLISTED GAS APPLIANCE <400,
UNLISTED GAS APPLIANCE >400,
USED APPLIANCE <400,000 BTU
LSEWHERE)-
000 BTU _
000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <16,000 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 =
NOTE: MIMUM PERMIT FEE IS $35.00
7"---
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=
West 1303 Broadway AvenuertSpokane, WAS 93260 Safety
(509) 456-3675