1990, 03-23 Permit App: 90001054 Woodstove-)s'
MECHANICAL IPEAMirtild443CMION FORM
Information Worksheet
JOB STREET ADDRESS: 5 30.16
CITY/STATE/ZIP:401^^-er LAJ PARCEL NUMBER:Q11/579(,/---(1/,
OWNER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street)
(City/State)
MECHANICAL WORKSHEET, FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DUCTWORK SYSTEM_ _
WOODSTOVE/INSERT _
GAS WATER HEATER ETU
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 1,001-1750M BTU_
REFRIG +1,750M BTU - -
HEAT PUMP & AIR CONDITIONER -0-3 TONS
HEAT. PUMP & AIR CONDITIONER 3-15 TONS
HPAP PUMP & AIR CONn2PTONER 15-30 TONS
MOM
JOE HOLLENBACK
Sales Associate
923-1991 RES: (509) 489-2035
929 Sprague Av(,. s Spokane, .A 99216
TOPPER AND AS$OC.u►T!S, INC.*=REALTORS
EACH OFFICE OWNED ANA OPERATED INDEPENDENTLY
50 TONS
TONS
•7 OF' HOOD)
BTU -
BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU_ _
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000 CFM
(ZF)
= 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: MINIMUM PERMIT FEE I3 $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
EQUALS: TOTAL PERMIT
PEE DUE
Spokane Cour
est 1303 Broadwav
epartmen of BuiIdin--ctt� and Safety
avenue Spokane, WA 99260 (509) 4564675