1991, 01-29 Permit App: 91000291 Furance, PipingJOB STREET ADDRESS:
MECHANICAL .PERMIT .APPLICATION FORM
Information Worksheet
? /46' E ./.11.4J/6// r
CITY/STATE/ZIP: 5-1,,,,/e f -eve 444 ?.9a4
OWNER: j Ecka4,4
MAILING ADDRESS:
CONTRACTOR:
PARCEL NUMBER:
PHONE NUMBER: .r.7
(Street)
MAILING ADDRESS:
(City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
(Street)
(City/State)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION -OF UNITS UTNIT
DUCTWORK SYSTEM
WOODSTOyE/INSERT
GAS: WATER HEATER
HEATING'EQUIPMENT <100,000;BTU__
HEATING EQUIPMENT +100,000:.BTU __—
GAS::PIPING ,_: (EA :OUTLET) _ _ MEMO _ _ _ _
REFRIG„ '1-100M :BTU -(NOT A/C, OR HEAT PUMP
REFRIG ` 101=5001 BTU
REFRIG ,_501-1,000M:;BTU -
REFRIG 1;001-1",750M_ BTU
REFRIG'+1,750TU _ _ _ _
HEAT' PUMP & '--- 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 -
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <16,000 CFM
AIR HANDLER >10,000 CFM
=AMOUNT
x$10.00 =
x 25.00 =
x 10.00 =
x "12.00
x 15.00 =
x 1.00
x 12.00.`=
x :20.00
x ;25.00
x `'35.00
x 60.00 '=
x12.00=
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
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675