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1989, 12-27 Permit App: 89005342 Furnace, PipingMECHANICAL PERMIT -APPLICATION FORM Information Worksheet JOB STREET ADDRESS: // Tint Ir'i(14 fof CITY/STATE/ZIP:372DSPL,.O. GUI . 7 !+x"PARCEL OWNER: % cd.. + `t./) MAILING ADDRESS: NUMBER: f15'1/ - ♦'i PHONE NUMBER: e0-41 ` 9-C/ LI• (Street) i ' c.pr,•n "tom CONTRACTOR: a QL!.''_1�'1 F ''.ii.n9, (.,�,. E. 12710 Indiana Spo' ane, Washington 9216 MAILING ADDRESS: (City/State)'/ (Zip) A LICENSE NUMBER: A' (4144 C (43 A)) PHONE NUMBER: 9(vdl-0 - ia-( 0 Q (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH OF UNITS UNIT DESCRIPTION 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' TYPE II HOOD OR 12' PTN. OF 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 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 /,;J .0 /cti) NOTE:INIM SIGNATURE O' M 'ERM j FEE IS $35.00 I ►, / SUBTOTAL $ ('3.00 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 38', 027 Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675