1994, 05-24 Permit App: 94004687 Furnace, ACt-5org, x0512
MECHANICAL PERMIT APPLICATION FORM
\fit s lnforrrztion Worksheet
JOB STREET ADDRESS`S "t o 3 E Nvrzti
CITY/STATE/ZIP: SIA. --L„, . 9t5 / 5 PARCEL NUMBER:
OWNER:9 /Lyric a Ain-yPi' 7 PHONE NUMBER: 7„9..w -% C) 2
MAILING ADDRESS:
/ / (Street) (City/State) , / /� (Zip)
CONTRACTOR: lV rn-rn hi zu .r, LICENSE NUMBER:/tt �ORCO CT 4 0 7 I L
0 / PHONE NUMBER: 5Z-9- y/ j S
MAILING ADDRESS: 16 S /o 3 -TM-, ± S/1 A2-1, a_--, Y9„9 /°_
(Street) /City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
W000STOVE/INSEa
GAS WATER HEATER
GAS EQUIPMENT <100,000'STU:(INCLUDES::'
GAS EQUIPMENT+100,000 STU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
:BOILER/REFRIG101400M 07th,; _ .
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG .1,0001 -1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP,& AIR' CONDITIONER:1530
HEAT PUMP & AIR CONDITIONER 30-50 TONS
' HEAT PUMP & AIR,CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE: COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD: ::'_ '- -
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS Nor COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE _>400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE ›400,000BTU,
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE (o_/eGw-
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00-
/
//.,n
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x60.00 =
x12.00 =
x 20.00 =
x25.00 =
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 50.60 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
/
/ j.G7
SUBTOTAL
$ P.t/, o o
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ -99.00
Spokane County Division of Buildings
West 131 'way Avenue Spokane, WA 99260 (509) 456-3675