1992, 03-10 Permit App: 92001432 Furnace, Piping MECHANICAL,PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: /; ''f 9r-) F_- U tZ 4 y l)A7
CITY/STATE/ZIP: c/ /nL 1U-e CL)J di4 9/6. /PARCEL/NUMBER: /5 -__--)1/ - 2(C3
OWNER: t)-Q/2/U EA)/ S PHONE NUMBER: cd &--- a 90 R
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: -1-/H 'S ye.Q7',i"5 of 1-2 C LICENSE NUMBER: zii0,+ s-Ai4c / n-'
PHONE NUMBER: 'Y k-?- y c a 7
MAILING ADDRESS: E' 71/3- Oc.dP 's 2d CA r f7!o 2A • f'9603
(Street) (City/State (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTOVE/INSERT . :::3 :. ::> '> >>
. x 25.00 =
GAS WATER HEATER x 10.00 =
GASEQUIPMENT<100,000 BTU INCLUDES : > :: x 12.00 =
U(�
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
A- .PIPI E <> . .TL < :: .:;: :.,::':::::> >::;> ;:<;::;:: ':<:> :`::: x 1.00 o
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REFRIG 101-BOOM BTU... >:::>` > > :: x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILER/REFRIG 1,0001 1,7750M BTU ;: x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
'HEAr PUMP&AIR CONDITIONER 0-3 TONS x 12.00 =
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP&AIR CONDITION ER 15 30 TONS `'`:::.::. :, x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
•HEAT PUMP&AIR CONDITIONER+50 TONS is x 60.00 =
VENTILATING FANS x 10.00 =
VE: LER :.:: ::>::: ::::;:'::::<.>::::>::>:>:::::" >'> :>:::>:::>:;:<:'::::;
x 10.00 =
-
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYPE II HO
OD . =
....:.:: :........::::.;:.;::.:::......
. . x 10.00
CLOTHES DRYER x 10.00 =
:....: x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUSNOT COVERED ELSEWHERE;;;:>:>:< :..`: x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
ULINSTED GAS APPLIANCE>400,000 BTU `> x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>400,000 BTU ' .:<..;> < x100.00 =
AIR HANDLER<10,000 CFM x 12.00 =
AI IT HANbLER 0,00a CFM x 15.00 =
SUBTOTAL $ /3
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
----
FEE
FEE DUE =$ 3S'
---vgSIGNATUR .lv/ , ..r,r[
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675