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1991, 09-19 Permit App: 91006101 Furnace, Piping
MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 3 3 CITY/STATE/ZIP: LT/Cci-,57-uir- Gr./7 9y;/-2, PARCEL NUMBER: Oi OWNER: TO 40/114-C PHONE NUMBER: ?2 MAILING ADDRESS: 73 3 /41/7.0-)4- /719 ..5"/179-t(Street) (City/State) (Zip) CONTRACTOR:, 5%.7/4.Z)-, LICENSE NUMBER: fiArell-7/ PHONE NUMBER: (f) MAILING ADDRESS: / z,..5-5/ (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER GAS EQUIPMENT GAS EQUIPMENT +100,000 BTU DUCTWORK) (A P1P1Mt /1t& AIITI . . . BOILER/REFRIG 1-lOOM BTU P ( -.6140014tiMg„. BIBOI1MLERPREEFRFRIG 501.-1,000M BTU DOU.EWREFRIG 10001-1,750M BOILER/REFRIG +1,750M BTU HEAT PUMP & AIR CONDITIONER 3-15 TONS HEAT PUMP & AIR „.- 15-30 TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS VENTILATING FANS • • TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) CLOTHES DRYER RANGE GAS LOG * • -• <400,000 BTU UNLISTED GAS APPLIANCE ELSEWHERE ULINSTED GAS APPLIANCE >400,000 BTU USED APPLIANCE <400,000 BTU USED APPLiANCE >400000 BTUAIR HANDLER <10,000 CFM NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 = x 25.00 = x10.00 = 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 = x25.00 = x 35.00 = x 60.00 = x10.00 = x10.00 = x 50.00 = x10.00 = x10.00 = x10.00 = x10.00 = x10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675