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1990, 02-07 Permit App: 90000454 Heater, Piping.e MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 7CU CITY/STATTE/ZIP: S{766ir4tE, bas -4, yq.7f L PARCEL NUMBER: OWNER: S4n4E PHONE NUMBER: MAILING ADDRESS: (Street) CONTRACTOR: 5-2ri_F (City/State) LICENSE NUMBER: PHONE NUMBER: (Zip) MAILING ADDRESS: So, 7e'6 JZ?,'NFR �4OK 4IVC, Ct)4J'?, Jg/am., (Street) (City/State) (Zip) MECHANICAL DESCRIPTION WORKSHEET/FEE SCHEDULE NUMBER X EACH OF UNITS UNIT DUCTWORK SYSTEM WOODSTOVE/INSERT GAS WATER HEATER HEATING EQUIPMENT <100,000 HEATING EQUIPMENT +100,000 GAS PIPING (EA OUTLET) REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-500M BTU BTU BTU REFRIG 501-1,000M BTU REFRIG 1,001-1,750M BTU REFRIG +1,750M BTU HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & HEAT PUMP & VENTILATING AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER AIR CONDITIONER FANS 0-3 TONS 3-15 TONS 15-30 TONS 30-50 TONS +50 TONS EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' TYPE II HOOD CLOTHES DRYER RANGE GAS LOG PTN. OF HOOD) 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 <10,000 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 = 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: MI IM/,U/M PERMIT FEE IS $35.00 SIGNATURE ,ven5 `�'"/&// Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675 SUBTOTAL PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE