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1992, 09-30 Permit App: 92008256 ACMECHANICAL PERMIT APPLICATION FORM Information Worksheet /1(71-1 7/ 7 L4 x-44 JOB STREET ADDRESS: CITY/STATE/ZIP: OWNER: C'., C, c-\ a- 'Z'a 5b 10;1 '1924 (O MAILING ADDRESS: PARCEL NUMBER: PHONE NUMBER: z 749fc (Street) (CitylState) CONTRACTOR: Banner Furnace & Fuei . 1nc.LICENSE NUMBER: BANNEFF378NT CONTACT: RUSS LUNDE PHONE NUMBER: 535-1711 MAILING ADDRESS: P.O. Box 4346 Spokane, WA. 99202 (Zip) DESCRIPTION (Street) (CitylState) MECHANICAL WORKSHEET/FEE SCHEDULE (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTOVEJINSERT GAS WATER HEATER GAS EQUIPMENT <100,000 STU (INCLUDDBS GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING (EA OUTLET) BOILER/REFRIG 1-100M BTU BOILER/REFRIG 101-500M BTU BOILER/REFRIG 501-1,000M BTU BOILERIREFRIG 1,0001-1,750M BTU BOILER/REFRIG +1,750M BTU HES$ 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) 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 SS•.Y 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 = NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE SUBTOTAL PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE .� 7 -- Spokane - Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675