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1992, 12-01 Permit App: 92010495 Furnace, Piping
ItILCHANICAL 1'ERMIT APl'LICA ION FORM InformatIon `Worksheet JOB STREET ADDRESS: CITY/STATE/ZIP: 14 CP -6 l,A V 61' - PARCEL NUMBER: OWNER: L MAILING ADDRESS: (Street) PHONE NUMBER: (%) I/- ") (�-/j (City/State) (Zip) CONTRACTOR: MARTIN SHEET METAL inc. LICENSE NUMBER: PHONE NUMBER: MARTISM17OKW 924-8088 MAILING ADDRESS: BLDG. #103 SPOKANE INDUSTRIAL PARK SPOKANE, WASHINGTON 99216 (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION I OF UNITS I UNIT AMOUNT ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) _ _ WOODSTOVE/INSERT _ _ _ _ _ ` _ _ _ _ _ GAS WATER HEATER _ _ _ _ _ _ _ _ _ _ _ GAS EQUIPMENT <1000,000 BTU_ (INCLU_DES _ GAS EQUIPMENT +1000,000 BTU_ _DUCTWORK)_ GAS PIPING (EA OUTLET) _ _ _ _ _ _ _ _ _ BOILER/REFRIG 1-100M BTU _ _ _ _ _ _ _ _ BOILER/REFRIG 101-500M BTU_ _ _ _ _ _ BOILER/REFRIG 501-1,000M BTU__ _ _ _ _ _ BOILER/REFRIG 1,001-11750M BTU _ _ _ _ BOILER/REFRIG +1,750M BTU_ _ _ _ _ _ HEAT PUMP & AIR CONDITIONER 0-3 TONS _ r_ HEAT PUMP & AIR CONDITIONER 3-15 TONS _ TEAT PUMP & AIR CONDITIONER 15-30 TONS _ HEAT PUMP & AIR CONDITIONER 30-50 TONS _ HEAT PUMP & AIR CONDITIONER +50 TONS _ _ VENTILATING FANS_ _ _ _ _ _ _ _ _ _ _ _ R _ _ _ _ _ _ _ _ EVAPORATIVE COOLES_ UR -1'2F TYPE I HOOD (PER 12' R 12'TPTN. OF HOOD) O TYPE II HOOD _ _ _ _ _ _ _ _ _ _ _ _ _ CLOTHES DRYER_ _ _ _ _ _ _ _ _ _ _ _r _ _ RANGE _ GAS LOG_ _ _ _ _ _ _ _ _ _ _ _ r_ _ _ 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 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 = jy / i 77 NOTE! MINIMUM PERM T F E IS $35.00 SIGNATURE SUBTOTAL I $ / 3 C, 0 PLUS: PROCESSING FEEI+ $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ Spokane County Department of Buildings Vest 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675