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1990, 03-05 Permit App: 90000735 Furnace, PipingMECHANICAL PE APPLICATION FORM 11 e 1/1/4-)S°0 Informa, Worksheet //MOO JOB STREET ADDRESS: X P. 78.2( kinoy. Y Se) CITY/STATE/ZIP: kout WonA PARCEL NUMBER:, -O2/ OWNER: MAILING ADDRESS: PHONE NUMBER: 9.28 -5 c:0 (Street) (City/State) (Zip) CONTRACTOR:AP/ 144LICENSE NUMBER: PHONE NUMBER: 9 a 4- OO I Z E. 111°4 7T1-071-116-7)114.1 100k (,d4 • 91:91:90E3© (Street) (City/State) (Zip) MAILING ADDRESS: MECHANICAL WORKSHEET/FEE SCHEDULE: NUMBER X EACH DESCRIPTIONOF UNITS ITNIT DUCTWORK SYSTEM WOODSTOVE/INSERT GAS WATER HEATER HEATING EQUIPMENT <100,000 BTU HEATING EQUIPMENT +100,000 BTU GAS PIPING (EA OUTLET) _ _ 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 _ _ 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' 5R-1 ' 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 = 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 = ,cr NOTE' SIGNATURE I UM PERMITE IS $35.00` West 13 SUBTOTAL $3. PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE okane CountyDepartment of BuNdin and Safety 3 Broadway venue Spokane, WA 90260 (5 9i 456-3675