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1991, 01-30 Permit App: 91000321 Furnace, PipingMECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: ) OLID I CITY/STAT ZIP: PARCEL NUMBER: OWNER: PHONE NUMBER: MAILING ADDRESS:- _ (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: - 1!231u) PHONE NUMBER::���;;2 �-Ouon MAILING ADDRESS: _ (Street) (City/State) (Zip) MECHANICAL WORKSHEET/FEE DESCRIPTION SCHEDULE NUMBER. OF UNITS X EACH PNIT; = AMOUNT DUCTWORK SYSTEM WOODSTOVE/INSERT, " GAS WATER _HEATER _ _ _ _ _ HEATING: EQUIPMENT <100., OOO ;BTU : - - -_ -_ HEATING ' EQUIPMENT >+100; 000 BTU, _ _ GAS PIPING (EA OUTLET).;- _'-,- _ - - _ _,_ REFRIG .1=1OOM . BTU ;` (NOT A/C.,OR'.:HEAT.:" PUMP) REFRIG:101-500M�BTU REFRIG 501-1000M 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 ,30-50 HEAT PUMP & AIR CONDITIONER +50 TONS VENTILATING FANS EVAPORATIVE COOLERS - - - _ - - - - - - TYPE I HOOD (PER 12' ;OR 12 , PTN. OF -HOOD) TYPE II HOODx.10.00 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 _ _ - - _ - _ _ X$10.00 x-25.00 = x.;10 00 = x :12 00. = x 15 X 1-00,= x 12.00 x: 0.00 = x,.25 00 x;35.00.- ,60.00 _ x:' x. 12.0C x 20.00 = x 25.00 = x: x`60.00 = x .` 10.00 = x"'10.00 = x-50.00. - 50.00.TYPE = 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 = �_ . Q -- © zjj SUBTOTAL PLUS: PROCESSING FEE EQUALS: TOTAL PERMIT NOTE: MINIMUM PERMIT JFEE IS $35.00 FEE DUE SIGNATURE Spokane County Department of Building and Safety West 1303 Broadwav Avenue Spokane. WA 9260 15091 $ lq<ov + $ 25.00 _ $ 39 66 456-3675