1990, 09-18 Permit App: 90004694 ACJOB STREET ADDRESS:
CITY/STATE/ZIP:
1 '
O:
MEGtIANIGAL PtKMI i APPLIGAI IUN tUKM
information Worksheet
/5<ivr - o2/
000724,/
LAA -PARCEL NUMBER: z4e,A6,4/
MAILING ADDRESS:
(Street)
CONTRACTOR:
PHONE NUMBER: - !7�
(City/State) (Zip)
LI CENSE 1UMBER: +1 `}r'z- kt? 4 (l o 1'2% 7
PHONE NUMBER: 4J LZ- S'i-�J
MA LINO 'ADD SS : { LL $ 62. Ai_
x. ,. r t },l(Street) (City/St
' MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
NUMBER X EACH
OF UNITS UNIT
�e) (Zip)
AMMEMMMEMMEMMIO
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 & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONDITIONER
VENTILATING FANS
0-3 TONS _
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS -
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
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 =
x10.00 =
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: MINIel PERMIT EE IS $35X00
SIGNATURE
LJ
�
SRokane_ County Department of_Building and Safetx�,
SUBTOTAL -
$
PLUS: PROCESSING FEE
25.00
EQUALS: TOTAL PERMIT
FEE DUE
AVE, *Elle