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1992, 11-03 Permit App: 92009708 Furnace MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 5 //1/4/ 2701-( -7 ,ff CITY/STATE/ZIP: .�, z_kl PARCEL NUMBER: sir OWNER: 4/('r ,L .7-, ��i PHONE NUMBER: C7.-7\7/C -- /17; MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: ti-r--71 ..7/A141 T-C6'r1u,�r=LICENSE NUMBER: 1/4-'7-. . flk_. / (y )� L PHONE NUMBER: 7 3 _92'1;13 MAILING ADDRESS: LP/")C� 77- 1 ?"-'.-- '--- l%vVz (Street) (Crity/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT = AMOUNT DUCTWORK SYSTEM x$10.00 = WOODSTOVE/INSERT x 25. 00 = GAS WATER HEATER x 10. 00 = HEATING EQUIPMENT <100, 000 BTU x 12. 00 = HEATING EQUIPMENT +100, 000 BTU x 15. 00 = GAS PIPING (EA OUTLET) x 1. 00 = REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12 .00 = REFRIG 101-500M BTU x 20. 00 = REFRIG 501-1, 000M BTU x 25.00 = REFRIG 1, 001-1,750M BTU x 35. 00 = REFRIG +1, 750M BTU x 60. 00 = HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ x 12. 00 = _ HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20. 00 = HEAT PUMP & AIR CONDITIONER 15-30 TONS x 25. 00 = HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35. 00 = HEAT PUMP & AIR CONDITIONER +50 TONS _ _ x 60. 00 = VENTILATING FANS x 10. 00 = EVAPORATIVE COOLERS x 10. 00 = TYPE I HOOD (PER 12 ' OR 12 ' PTN. OF HOOD) x 50. 00 = TYPE II HOOD x 10. 00 = CLOTHES DRYER x 10. 00 = RANGE x 10. 00 = GAS LOG x 10. 00 = MISCELLANEOUS (NOT COVERED ELSEWHERE) x 10. 00 = UNLISTED GAS APPLIANCE <400, 000 BTU _ _ x 50. 00 = UNLISTED GAS APPLIANCE >400, 000 BTU_ _ _ x100. 00 = USED APPLIANCE <400, 000 BTU x 50. 00 = USED APPLIANCE >400, 000 BTU x100 . 00 = AIR HANDLER <10, 000 CFM x 12 . 00 = AIR HANDLER >10, 000 CFM x 15. 00 = SUBTOTAL $ PLUS : PROCESSING FEE + $ 25 . 00 EQUAT- : TOTAL PERMIT NOTE: MINIMUM PERMIT FEE IS $35. 00 FEE DUE _ $ SIGNATURE Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675