1991, 10-14 Permit App: 91006811 Furnace, Pipingr^
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
S. lea go.
JOB STREET ADDRESS: 3 0
CITY/STATE/ZIP: S'Po,4vnpCe-la
OWNER: t oy vr^ 6-n/ 0-.+5
MAILING ADDRESS: iez bcti eS
PARCEL NUMBER:
PHONE NUMBER:
(Street) (City/State) (Zip)
CONTRACTOR: %vu S<'•z%X+us• /r7T '--c LICENSE NUMBER: rOL//{3fff?/3‘KC=
MAILING ADDRESS: 7,0'/ 4 c1 CI
PHONE NUMBER: O 4 --€:; 11 3
/k•/p, / Ct -' _
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
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/REFRIG 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFFiIG 1,0001-1,750M BTU
BOILER/REFRIG +1,750M BTU
:HEAT'PUMP&:AIR.CONDITIONER 0=3
HEAT PUMP & AIR CONDITIONER 3-15 TONS
;NEAT;P.UMP;BAIR.C.OND1TlONER.15=30,TONS.__:
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT: PUMP;&`AIR[ CONDITIONER +50 TONS'. °a::;;,`.::::
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
RANGE th::i ._.:
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE,
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS: APPLIANCE>400,000 B.TU
USED APPLIANCE <400,000 BTU
U$D APPLIANCE,400,000BTU
AIR HANDLER <10,000 CFM
AIR HANDLER:>10,000 CFM::_
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE -Alt- z
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 =
/,ov
/.00
SUBTOTAL
$ /3 10 0
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 3 9-'00
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675