1989, 06-20 Permit App: 89001844 Furnace, Piping r
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: S. 416 Leta
CITY/STATE/ZIP: Spok. . Wa. 99216 PARCEL NUMBER: i /2- /230
OWNER: Betty Lans PHONE NUMBER: 924-0270
MAILING ADDRESS: Same
(Street) (City/State) (Zip)
CONTRACTOR: Sturm Heating, Inc. LICENSE NUMBER: STURMI*210 QF
PHONE NUMBER: 325-4505
MAILING ADDRESS: E. 204 Indiana Spokane, Wa. 99207
(Street) (City/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 1 x 12. 00 = 12 .00
HEATING EQUIPMENT +100, 000 BTU _ _ _ x 15. 00 =
GAS PIPING (1 4 004 LETS) /_�41 6'1-- 1 x �,` . 00- = 1 .00
GAS PIING (5 OR MORE. EACH: )✓ 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 $ 13.00
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT
NOTE: MI I UM PERMIT FEE, IS $35. 00 FEE DUE = $ 38.00
SIGNATURE 4-4- .4-1-1 LtJ 2� �]
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675