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1991, 08-22 Permit App: 91005201 Furnace, PipingJOB STREET ADDRESS: MECHANICAL PERMIT APPLICATION FORM Ir.,formation Worksheet /3/5- CITY/STATE/ZIP: 3/SCITY/STATE/ZIP: >1 a ;(,fly 9gcl©<o PARCEL NUMBER: 0 ED7 `� - /' J OWNER: 111( 410 MAILING ADDRESS: f(% PHONE NUMBER: 509 - 9 a g ' 834 n$ . 1 3 (5 c-gotc-y-kvno2 (Street) CONTRACTOR: )il e Ad MAILING ADDRESS: too / 5'70'7 (Street) . a --lea rLc2 - 900 - (City/State) (Zip) LICENSE NUMBER : SE - ? 2 - Sie- 3 7a /c) / PHONE NUMBER: ,���fA -070 - X { 3w4 -b apt 0 1 L-04 Q9c o City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER DESCRIPTION OF UNITS X EACH UNIT = AMOUNT 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 501-1,000M BTU REFRIG 1,001-1,750M BTU REFRIG +1,750M BTU 0-3 TONS 3-15 TONS 15-30 TONS 30-50 TONS +50 TONS HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER HEAT PUMP & AIR CONDITIONER 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 1 x$10.00 = x 25.00 = x 10.00 = x 12.00 = x x x x x x x x x x x x x x x x x x 1,.Q,g = 1.00 = 12.00 = 20.00 = 25.00 = 35.00 = 60.00 = 12.00 = 20.00 = 25.00 = 35.00 = 60.00 = 10.00 = 10.00 = 50.00 = 10.00 = 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 = /a ,c90 / D4 NOTE: ,MINIMS • I� FEE IS $35.00 SIGNATURE SUBTOTAL $ 1300 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ 3�S.oa Spokan : Cou Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675