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1991, 02-20 Permit App: 91000613 Furnace, Piping MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: CITY/STATE/ZIP: PARCEL NUMBER: i % Z7� ) (9 " OWNER. A-4042-0/v1.. PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip)� CONTRACTOR: /9/C) fO -ivi ° LICENSE NUMBER: P/�.rc._�r /V// J P PHONE NUMBER: 4/747,2 - 7:7,2_731 MAILING ADDRESS: 76 ///r1 i /5767,,, -f r.r/ /3 .5"?'`) (Street) (City tate) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT = AMOUNT ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) _ _ x$10.00 = WOODSTOVE/INSERT x 25.00 = GAS WATER HEATER x 10. 00 = GAS EQUIPMENT <1000, 000 BTU_ (INCLUDES / x 12.00 = /.2. vv GAS EQUIPMENT +1000, 000 BTU _DUCTWORK) x 15.00 = GAS PIPING (EA OUTLET) / x 1. 00 = BOILER/REFRIG 1-100M BTU x 12.00 = BOILER/REFRIG 101-500M BTU x 20.00 = BOILER/REFRIG 501-1,000M BTU x 25.00 = BOILER/REFRIG 1,001-1,750M BTU x 35.00 = BOILER/REFRIG +1,750M BTU x 60. 00 = HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ x 12.00 = HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20.00 = HEAT PUMP & AIR CONDITIONER 15-30 TONS - x 25. 00 = HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35. 00 = HEAT PUMP & AIR CONDITIONER +50 TONS _ _ x 60.00 = VENTILATING FANS x 10. 00 = EVAPORATIVE COOLERS x 10. 00 = TYPE I HOOD (PER 12 ' OR 12 ' PTN. OF HOOD) x 50. 00 = TYPE II HOOD x 10. 00 = CLOTHES DRYER x 10. 00 = RANGE x 10. 00 = GAS LOG x 10. 00 = MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ x 10. 00 = UNLISTED GAS APPLIANCE <400, 000 BTU_ _ x 50. 00 = UNLISTED GAS APPLIANCE >400, 000 BTU _ _ x100. 00 = USED APPLIANCE <400, 000 BTU x 50. 00 = USED APPLIANCE >400, 000 BTU x100. 00 = AIR HANDLER <10, 000 CFM x 12 . 00 = AIR HANDLER >10, 000 CFM x 15. 00 = SUBTOTAL $ / d ) PLUS: PROCESSING FEE + $ 25. 00 EQUALS: TOTAL PERMIT NOTE: MINIMUM PERMIT FEE IS $35. 00 FEE DUE = $ $ F SIGNATURE Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675