1992, 09-03 Permit App: 92007215 Furnace, PipingMECHANICAL PERMIT APPLICATION FORM n n
Inffrmation Worksheet -I� L
Lig D__
E73I5 Mfl )&l/ Ave.. ,`
p WA Qq t 2 PARCEL NUMBER: 0 U
OWNER: C 51/141.
MAILING ADDR
JOB STREET ADDRESS:
CITY/STATE/ZIP: Sp0A
- led. PHONE NUMBER: 92e - 8e3
-Pa- MAX wa l/
(Street)
Spaka.te
(City/State)
WA 99a -i
(Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
w000STOVE/INSERT
GAS WATER HEATER
• GAS EQUIP. MENT<100,000 BTU (INCLUDES
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS PIPING;(EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101+5004:BTU' -:_=
BOILER/REFRIG 501-1,000M BTU
BOILER/9EFRIG1,0001-1;750MBTU'
BOILER/REFRIG +1,750M BTU
HEAT PUMP AIR CONDITIONER 0-3 TONS .
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT ,!um p '&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„HOOD:.,:'
CLOTHES DRYER
RANGE :,,...:'' ':::
GAS LOG
MISCELLANEOUS'(NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED 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
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
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 =
S
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