1989, 09-28 Permit App: 89003662 FurnaceMECHANICAL PERM i'APPLICATION FORM 152 G-7
Information Worksheet
JOB STREET ADDRESS: N. / a l 1'`? i&:.4 �► /
CITY/STATE/ZIP: S"--/0S"--/0A /Ca h .. Uja . PARCEL NUMBER: i� J tt'7" - 2.00-1
e6//1/5 56
OWNER: 4#5.e. Sp 1•hy (Eav,t /3,121444 PHONE NUMBER: 4i407- as ;u5 2
MAILING ADDRESS: N. Si d ! - /9 a✓i Siem Sl'`- S/aKa N r 14.4 1. i 9 Re)?
(Street) (City/State) (Zip)
CONTRACTOR: F75#--0 u. So K s /e/&i LICENSE NUMBER: /=D t./JQ 31' /9 / 3 G K ir-
PHONE NUMBER: y 6 G- 4/ 9
MAILING ADDRESS: /30Y 4t 4 4t d c,c.4. 9440 a/
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
=AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M 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
PTN. OF HOOD)
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 <10,000 CFM
AIR HANDLER >10,000 CFM
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 4.00 =
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 =
/2.00
NOTE: MINI ERMIT F�.00
SIGNATURE /f•Z
SUBTOTAL
$ o
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$37.00
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675