1992, 06-09 Permit App: 92004140 Furnace, PipingMECHANICAL PERMIT APPLICATION FORM
information t� Worksh et ;
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JOB STREET ADDRESS: %�'i
1
CITY/STATE/ZIP: C #(0tP / , C' - 21-1 , PARCEL NUMBER: c/ f
OWNER: �� �/t/ PHONE NUMBER:
MAILING ADDRESS:
CONTRACTOR:
MAILING ADDRESS:
(Street)
'0G
(City/State) (Zip) A
LICENSE NUMBER: .0 PAEf l V / cJ 1"
PHONE NUMBER: ‘7142- ?...?2
l®c, 8- %-- jlic 7 - > /3 9-,_2_c;)
(Street) (City/ tate) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
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
HEAT'PUMP" AIRCONO(T 3WIEOP_T£*tS_.__
HEAT PUMP & AIR CONDITIONER 30-50 TONS
VENTILATING FANS
TYPE I HOOD (PER 12' OR 12' PTN.OF HOOD
CLOTHES DRYER
GASLOG .::::.........:...........:.........:............:..........---------..........---...--
...........LO.........
misqatAN US (N O EKED ELSEWH
UNLISTED GAS APPUANCE <400,000 BTU
ULINSASAP
USED APPLIANCE <400,000 BTU
USED APPLI NCE 4OOt0+f>4? BTU
AIR HANDLER <10,000 CFM
AIR HANDL 51 1,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
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 =
x35.00 =
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 =
/a. G c)
/ . o -c)
SUBTOTAL
$ 7 c...‹).
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675