1991, 10-22 Permit App: 91007078 Furnace, PipingMECHANICAL r ,ERMIT APPLICATION FORM
i' +nation Worksheet
Oki;we(i
JOB STREET ADDRESS: C 1(01(a
CITY/STATE/ZIP: `).poKikr.AC. v3t'.
OWNER: 1�Q Ilil �1 An(
'ft ' 4 PARCEL NUMBER:
PHONE NUMBER: `Eat -35-a/P
MAILING ADDRESS: F' l(¢Iu tMQziv do 9`0I)...
(Street) (City/State) (Zip)
CONTRACTOR: 00.-)+� LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
,w000swyeimeRT
GAS WATER HEATER
GAS EQUIPMENT_<100,000 STU:(INCLUDES:
GAS EQUIPMENT+100,000 BTU DUCTWORK)
GAS:PIPING..(EA,OUTLE7).,::':
BOILER/REFRIG 1-100M BTU
B0ILER/REFRIG:101 500M B(t7
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001-1',750M
BOILER/REFRIG +1,750M BTU
HEAT>PUMP B' AIR:iCONDITIONER 0-3 TONS : ':€:' ::
HEAT PUMP & AIR CONDITIONER 3-15 TONS
:HEAT;PUMP&'AIR. CONDITIONER 15-30: TONS '
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEA•T:PUMP:&AIR_C.ONDITIONER;+50_TONS':;:r'=
VENTILATING FANS
.EVAPORATIVECOOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
:.TYPE11 Hoary
CLOTHES DRYER
GAS LOG
•MISCEUXNEQVS:NOTCOVEREO ELSEINHEf E
UNLISTED GAS APPLIANCE <400,000 BTU
U LI NSTED;GAS:_APPLIAt4CE>400,000: BTU:
USED APPLIANCE <400,000 BTU
USED AP,PLIANCE>400,000:BTU::::
AIR HANDLER <10,000 CFM
'AIR HANDLER 710,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= 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 =
lc
16-ob
1
Lou
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
_ $
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675