1992, 07-13 Permit App: 92005182 Furnace, PipingJOB STREET ADDRESS:
CITY/STATE/Z
OWNER:
MECHANICAL-PEP.MIT APPLICATION FORM
qe Ir`ormation Worksheet
9021
PARCEL NUMBER: /$ %%/ • /56/0
.Qi PHONE NUMBER: 9;1 05-69`
MAILING ADDRESS:
(City/State)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street)
(Zip)
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT.
GAS WATER HEATER
GAS EQUIPMENT: <100,000 BTU (INCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
.GAS PIPING.(EA.OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG1101=500MBOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG ,,1,,0001-1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP& AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
;HEATPUMP'& AIR CONDITIONER 1530
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP &"AIR CONDITIONER 4150 TONS
VENTILATING FANS
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
'ULINSTED 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
NOTE: MINIMUM PERMIT FEE
SIGNATUR
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
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 =
K !
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675