1991, 07-10 Permit App: 91004096 Furnace, PipingJOB STREET
MECHANICAL PERMIT APPLICATION FORM
� Information Worksheet
(Of t PV-t/A .�o,nnf� 1 0
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: �e � IV aw PHONE NUMBER:
MAILING ADDRESS: -gc,-X-
C4
(Street) (City/State)
CONTRACTOR: (! -rT C4 f LICENSE
MAILING ADDRESS: ,5, S -Q
DESCRIPTION
NUMBER:
PHONE NUMBER:
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT +100,000 BTU DUCTWORK)
...........................................................................................................................................
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 3-15 TONS
W`.:,:•:.<>P :lPA.,�IR. NDITf .NSR
:. ......... .
EA')'....U.....:.:.:. CO..............Q... 1.5.3tl::TONS> .... =
HEAT PUMP & AIR CONDITIONER 30-50 TONS
�'f.�,•P�,,� A;t#� ��N)��'C1�.NEI� +50 TL��S <:_>: �:
VENTILATING FANS
::,:x..a.W o-� ......::::.-.,•:::n.::.v:.afcx::>;xa:•:d:;;:,:::;�::::xx::�;:::>;a'.-::::::s:::::;ix:;>:.,:-::;: i-x::Z
TYPE -1 HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
...
MISt�ILLANEOUS (NOT COVERO ELSEWHERE .
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPL
..:
IANCE>400,000 BTU .
....::.:..._ ........... __ _:....
USED APPLIANCE <400,000 BTU
>< » <<> ;> .-
..........................
.....::,
AIR HANDLER <10,000 CFM
AIR,...HANDLER >-10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE �
Spokane
(zip)
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
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 =
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 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675