1990, 10-09 Permit App: 90005252 Furnace, Piping - MECHANICAL PERMIT APPLICATION FORM .
Information Worksheet
JOB STREET ADDRESS: 1Y,J . Lig(Q \-1\ ti\1 Volt Ris
CITY/STATE/ZIP: (acQ A-M ca. PARCEL NUMBER:
OWNER: PHONE NUMBER: C)/(Q6, ( Ct
MAILING. ADDRESS: .1-1q � CI ��4 X�n� � S � q
(Street) ( ty/Sta4e) (Zip)
CONTRACTOR: __.<1s1a LICENSE NUMBER:
�(PHO(nN�E NUMBER: q . -- , O Q. Q
Ce
MAILING ADDRESS: K, , z4 Q 1 � v`� e a.• 9 a i_‘,
(Street) zity/State) (Zip)
{a � - , mfr `,i' i,.>Y MECHANICAL WORKSHEET/FEE SCHEDULE: ', ,ai k • t w '`� #'„
NUMBER X EACH •T; ,.
DESCRIPTION �`r OF UNITS :` UNIT AMOUNT
DUCTWORK SYSTEM_ _ ' x$10 00 .,,sgiA, z;
WOODSTOVE INSERT _4 x'. 25 00 „r•.. °2!
, GYWATK, TER� �4Ax 10.00' ;,, fa ay,4, { ,
'4'' x 12.00 R tf .
r f'4
tgot
f r 0--.-,
r IlEATI��.vr X ' C ,'.5. V Y.J Q� 0,1,-B i YM"' M. } - !A}.�I j �., `',' �,,
A T;,,,.7-4, Y''''--. .-,x.' 1 ' �, . 0 000 ;: 0 ,40-,,,,04, ,t d, x 15 '00< r',F k
�4.11>h. + :'i, 1.rhx �. � :J 4,,,,,,,,„:44,,, n� * Ft �'— t, .x Ca i1 �I a+.•.;os;.,v^- r t x `
.}(g,• :, IPI ` 1OUT �.� +AkF.#a , .� fir0._,../,,,...;;;,,,,' ° , ,e x1"*f. 1 00>~, h�f
?�3 �., � ")iXi vs � �Me y r'N t,,ns9: sure f�"T�r, s 14r •,..n ..E•,�q.",n'h�a. �, ,��J� .w�. .+
NOT 0 s )
may. = ,(,} Az.. r ,. , x.=12.,00, 7
' '' iT f'---7-+� k.`': —itm ,fr. t';\` mow. '' l.�1 '' 1 - ,' fA'd f L �� F �}
•
ocl
'if�iet R: f o o oI4 BTEJM, y' .:'—#'1;`1
h ' ,. f. `Y N. "r s 4 9. '"2144 E ' , + ,.:��-' r�s ,Y
I,Oft
��, .. 1� ..,, n �>' dS ,^t 4 < . x 25•00 >, r
RE
a ,. F 1 ti T i '36'435:004f:
, _. y ,1 v°' v: ,
�{ � F M
RE '1 `00g , ,L,750 # BTU ` , L 44a '. - ; ' x 35.00 , ,,.
t ccs � w 1 .
' RE .G' 1 SOM't,BTU ,�d � s � .a '.,�� x 60 00 t A _
we +w tla• 4< �^ t ,�u r _, « t f "+€yfKx
ta#St` � $ & AIR CONDITION 0` TONS. r tx, x' 12 OCA f h
t eHEA *&t AIR; 'CONDITIONER-x3-15 TONS - f x..20-00-•:'i; r Y " , h
' r R t'T�'l b^ .,.! z gp fit: t:�, ,
EAST '�K &'�AI] #cCONDITIONER3rT5' 304TO IS ., x„.25.00 ., :t
HEA' :' r '&''AIR"CONDITIONER 0�5 SONS _ ,A17","''' x.: 35:00 - fi�
'' T PUMP, Sii,4�AIR CONDITIONER.;+50. TONS _ _ x' 60.00 ',, �' 4 ^ ^ �:, �'
't�'VENTILATI TG FANS *# _ Nov _ �� _ ,k.,,,,,, -::;,0,-,'
n
x 10.00 .
"";EVAPORATIVE. COOLERS " " ' ;,Y 'tx
'TYPE. I`HOOD :(PER' 12' OR '12' ' PTN. `OF.' HOOD) x 50.00 = Y, ; '
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 $
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE = $
SIGNATURE
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675