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1991, 07-24 Permit App: 91004469 Furnace, Piping
MECHANICAL PE APPLICATION FORM l ! Information Worksheet / JOB STREET ADDRESS: S `7 / /EGO `� C T - CITY/STATE/ZIP: �P6 jc22-6) OWNER:aks(35iE c/ MAILING ADDRESS: ,/ PARCEL NUMBER: PHONE NUMBER: (Street) CONTRACTOR: Ae d �L/1 MAILING ADDRESS: ‘d 7' (Street) (City/State) �/ (Zip) �7 LICENSE NUMBER: _2 P -L PHONE NUMBER: 02;2- 72_)-72 / i7m7 /7.050 (City/ tate) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQUIPMENT +100,000 BTU DUCTWORK) BOILER/REFRIG 1-100M BTU BOILER/REFRIG-501-1,000M BTU BOILER/REFRIG +1,750M BTU • HEAT PUMP & AIR CONDITIONER 3-15 TONS �T PUMp, &vAIR ONDI-T<1oNEA 15-30 TONS HEAT PUMP &AIR-CONDmONER 30-50 TONS ATaMar VENTILATING FANS TYPE! HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER GAS LOG_;;;;:-;::..-.... iNIS ELL 4NEOUS'(NOT _COVERED ELSSEWHE• R1 UNLISTED GAS APPLIANCE <400,000 BTU ULINSTEO GAS APPLIANCE>400,000 BTU USED APPLIANCE <400,000 BTU USED AP LI:ANC ±4 t O t 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 = x25.00= x 10.00 = x12.00= x15.00 = x x 1.00 = x 12.00 = x20.00= x25.00 = x 35.00 = x60.00 = x12.00 = x 20.00 x.25.00 = =x35.00= [x 60.00 .T= '{ x10.00 _ x 10.00 = x 50.00 = x10.00 = x 10.00 = x10.00 = x 10.00 = x10.00 = x 50.00 = x100.00 = x50.00 = _: / .3— /, 0--o ::Ci. '-i�a. Rsr' ,!•� ,, x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ /6.so PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane. WA 99260 (5091 4R6-1875