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1989, 10-04 Permit App: 89003801 FurnaceJOB STREET ADDRESS: MECHANICAL PERMIT APPLICATION FORM Information Worksheet E. 13923 Nixon CITY/STATE/ZIP: Spokane, Wa. 99216 PARCEL NUMBER: OWNER: rank Jolley MAILING ADDRESS: same as above CONTRACTOR: Norco MAILING ADDRESS: (Street) Heating & Air Cond.- Inn_ E. 5051 Trent PHONE NUMBER: 926-8791 (City/State) (Zip) LICENSE NUMBER: NORCOHC17ORZ PHONE NUMBER: 534-4975 (Street) Spokane, Wa. 99212 (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 +1,75OM BTU 0-3 TONS 3-15 TONS _ 15-30 TONS _ 30-50 TONS _ +50 TONS HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER VENTILATING FANS 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 1 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 = 12.00 NOTE: MINIMUM PEI! FEE I8 $35.00 SIGNATURE /�'h cl „ e� Spokane County Department of Building and Safety5 West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-367 SUBTOTAL $ 12.00 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 37.00