1989, 10-18 Permit App: 89004143 Furnace, Piping110 ?( r°
MECHANICAL PERMIT APPLICATION FORM
Information ,Worksheet
JOB STREET ADDRESS: / ,3 / S . (/ ,' e v c e_.
CITY/STATE/ZIP: 4o0), s, Y GJh , % 9J O PARCEL NUMBER:
t
ezi -113--9681
OWNER: Me /cam t / rif 6& (-c) L ' S PHONE NUMBER: ! c (% 8 F 5/
MAILING ADDRESS: / 02 / 5 P, ` r v` c � o ��cr K r Cc_)/ii_ . 9 v 4
(Street) ( i.ty/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT _. = AMOUNT
DESCRIPTION
(Zip)
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 50171,000M BTU_ _
REFRIG 1,001-1,750M BTU _
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_
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
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00>=.
x 15.00
x 1.00 =
x. X1.00
x'-=12.00
x 20.00 =
x 25.00.=
x35.00=.
x
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 =
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
$
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 {509) 456-3675