1994, 11-03 Permit App: 94010919 Furnace, Piping MECHANICAL PE IMIT•i1PPLICATION FORM
Information Worksheet q q- «}g 0
JOB STREET ADDRESS: J 3 507 X# i2. e ,^..s I et4, fr
CITY/STATE/ZIP: ... /lanae' PARCEL NUMBER:
OWNER: P4 2 I:f?S t 4r° or/ PHONE NUMBER: 9.2 `,";. as
MAILING ,.^
MAILING ADDRESS: ` cc 3 S C, rs' .__
(Street) (City/State) (Zip)
CONTRACTOR: irym-e, (7- iii_ec _-..-, LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS: (dQr u-_a / 1. "/r-'' 4.7
(Street) (City/State) (Zip)
MECIIANICAL WORKSHEET/FEE SCHEDULE
NUMBER 1 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<100,000 BTU (INCLUDES x 12.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) I x 15.00 = _/S pp
GAS PIPING (EA OUTLET) / x 1.00 = / „ 00
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REFRIG101.500M BTU x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIG:1,0061-1,750M BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP&AIR CONDITIONER 0-3 TONS x12.00 =
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 =
ULINSTED GAS APPLIANCE>400,000 BTU x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =-
USED
USED APPLIANCE>400,000 BTU x100.00 =
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER>10,000 CFM x 15.00 =
SUBTOTAL $ 404r
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTAL PERMIT
FEE DUE =5 6147
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SIGNATURE J�r'� --- ✓-- 4( ."
Spokane County Division of Buildings
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