1991, 09-16 Permit App: 91005877 Mechanical FixturesJOB STREET ADDRESS:
A
MECHANICAL PERMIT APPLICATION FORM /9 OD
Information Worksheet N1
N y / 5 9 e o G �e(fS aeo 0
E/ZIP: PARCEL NUMBER: 026(k. I -34'61
OWNER: �a �. RC4 _ PHONE NUMBER: fat' 0.2 9
MAILING ADDRESS:
(Street) (City/State)
CONTRACTOR: Banner Furnace & Fuel, Inc .LICENSE NUMBER: BANNEFF378NT
CONTACT: RUSS LUNDE
(Zip)
PHONE NUMBER: 535-1711
MAILING ADDRESS: P.O. Box 4346 Spokane, WA. 99202
DESCRIPTION
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/1NSERT
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
.. ................. ..
BOILER/REFRIG 1,0001-1,750M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS
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 (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED 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 =
x10.00 =
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 =
/- a
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
$ l 3 00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
3d;