1990, 08-01 Permit App: 90003682 Furnace, Water HeaterMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: 4217 7 n0 "a te
CITY/STATE/ZIP: ;-no7721-1�, 1Ti,
OWNER: L. J. Larson
99726
,r
0okane, _ 99206
MAILING ADDRESS:
CONTRACTOR:
3. 4217 t 1-.ondra Dr.
PARCEL NUMBER:257iii
PHONE NUMBER:
(Street)
O'Torco Tieat in,r`; L Air cond.
MAILING ADDRESS:
5051 E. Trent,
(Street)
pokano, WA 99206
(City/State) (Zip)
LICENSE NUMBER: ITOLCCT «17 102
PHONE NUMBER: 5
,; n, -p r, 101 99212
(City/State) (Zip)
-MECHANICAL: WORKSHEET/FEE - SCHEDULE
NUMBER X EACH
-OF UNITS UNIT
DESCRIPTION
DUCTWORK,SYSTEM•
WOODSTOVE/,INSERT.
GAS WATERHEATER__._ _,_.
HEATING<1:: EQUIPMENT 00,000:;
HEATING EQU;IPMENT +100; 000 B
GAS PIPING;:(EA.OUTLET) _
REFRIG:-.1 100M.' BTU =. (NOT'; A/C. O
REFRIG::,101',-500M `BTU .'.�
REFRIG?;501."1'.P90M BTU_ *.
REFRIG . 1,,001 ,1, 750M rBTU
REFRIG .+1750M• BTU
HEAT. PUMP,. TM AIR CONDITIONER
HEAT•PUMP & ; `AIR R
. ` CONDITIONE
HEATPUMP &- :AIRCONDITIONER
HEAT--PUMP.&.AIR' CONDITIONER
HEAT PUMP. AIRF CONDITIONER
VENTILATING:.FANS
R-.. HEAT -:;PUMP) ;,
-0=3 ;TONS .
-3,15 TONS
'15-30 TONS
30-50 ..TONS
:+50.. TONS
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
= AMOUNT
x$?0.00 =
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 =
10.00
12.00
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
///
SUBTOTAL
$ 22.00
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
$ 47.00
Spokane County Department of Buildingg and Safety
West 13113 Broadway Avenue Spokane, WA 99260 (509) 456-3675