1990, 12-24 Permit App: 90006900 Furnace, PipingJOB STREET ADDRESS:
CITY/STATE/ZIP: �pCO kit 9q(2/ ,2, PARCEL NUMBER:
OWNER:5/7Y1 e'r Ian ' 1 5 - n PHONE NUMBER: 535 5/ 7
5 A M �
I (Street) I (City/State) (Zip)
CONTRACTOR: M a 1-4) ee 4- M e Ta / LICENSE NUMBER: Al 4 .r I Stn 176 k ul
MECHANICAL PERI T- PPLICATIONORM
Information Worksheet `
MAILING ADDRESS:
MAILING ADDRESS: 8I
103 S kzn
treet)
PHONE NUMBER: 9e? 2/ 90 g g
In u$�r►o 1 9'nrk S k Y1.v QQ1?/
(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 PIVING (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
EVAPORATIVE
AIR CONDITIONER 0-3 TONS _ _
AIR CONDITIONER 3-15 TONS
AIR CONDITIONER 15-30 TONS _
AIR CONDITIONER 30-50 TONS _
AIR CONDITIONER +50 TONS
FANS
COOLERS
TYPE I HOOD (PER 12' OR 12'
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
PTN. OF HOOD)
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 =
x60.00 =
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 =
NOTE: MINIMUM PERMIT FEE I8 $35.00
SIGNATURE
SUBTOTAL
$°I"
o
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
0
_
�J
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane. WA 99260 (509) 456-3675