1991, 10-22 Permit App: 91007082 Furnace, PipingJOB STREET ADDRESS:
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
• .
CITY/STATE/ZIP X C V \3 o�CQ PARCEL NUMBER:
OWNER: ,X`P \m PHONE NUMBER:
MAILING ADDRESS: c-7P\�
(Street (City/State)
(Zip))
CONTRACTOR: ..-5\t'S\ Y rC) \CE' LICENSE NUMBER:c X PR J�--
PHONE NUMBER: &O\.O
MAILING ADDRESS: • C\3--617 \v\S\ZI`(\ . \ °Pka•
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
W O O D S TO V E/ I N S E
GAS WATER HEATER
..............
GAS EQUIPMENT «OQ OOo BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEATPUMP &AIR CONDITIONER 0 3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
.................................
HEAT PUMP & AIR CONDITIONER 15 30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP $� AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPEII HOOD
CLOTHES DRYER
RANG:E.:
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>400000 BTU
AIR HANDLER <10,000 CFM
.,:........................................................................
AIR HANDLER >10 000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= 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 =
x60.00 =
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 =
SUBTOTAL
$ n , CO
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 35\.OQ
SIGNATURE �wv\ •���L
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675