1991, 10-24 Permit App: 91007141 Water HeaterMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: eS, .21 10 _ S Ll /J C t $ E
CITY/STATE/ZIP:
OWNER: ti`Zci y /'►'r0/V p ,2F} SC >11 -'0 --
MAILING
c?MAILING ADDRESS:
CONTRACTOR: Banner
PARCEL NUMBER:
PHONE NUMBER:
-
(Street) (City/State)
Furnace & FueJ , Inc .LICENSE NUMBER:
PHONE NUMBER:
Spokane, WA.
CONTACT: RUSS LUNDE
MAILING ADDRESS: P.O. Box 4346
(Zip)
BANNEFF378NT
535-1711
99202
DESCRIPTION
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERT' .
GAS WATER HEATER
GAS EQUIPMENT <100,000 BTU (INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG 101-500M BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1,0001-1,750M BTU
BOILER/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' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED 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 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 =
t). 0 0
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
$ ,o..t,.
$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
3r-0
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675