1989, 05-04 Permit App: 89001157 Furnace, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: r Cj% a a ()Ail_ 7,coPy
CITY/STATE/ZIP: Sp)A;7'--�'✓ ARCEL NUMBER:
OWNER: C L (2 .°/2 A 1/c A r PHONE NUMBER:
MAILING ADDRESS:
CONTRACTOR: �%�P-1-5 -��2 p%f /AT' pL
(Street)
LICENSE
�
^ PHONE
C,
MAILING ADDRESS: - --0 cl.p/VS yeN
(Street)
c/ ? 9 5a
(City/State) (Zip)
NUMBER: S(fX,'
NUMBER: /7/P•-- 9 6' a
CYAdriyU , Coil- 9 9063
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
OF UNITS UNIT
DESCRIPTION
=AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (EACH OUTLET:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,00014 -BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS _
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
HOODS
CLOTHES DRYER
RANGE
GAS LOG
UNLISTED GAS APPLIANCE
AIR HANDLER - 10,000 CFM
x
x$ 6.50 =
x 10.00 =
x 6.50 =
x 9.00 =
x 11.00 =
x .50 =
x 9.00
x 16.50 =
x 22.50=
x 33.50 =
x 56.00
x 9.00 =
x 16.50 =
x 22.50 =
x 33.50 =
x 56.00 =
x 4.50 =
x 6.50 =
x 6.50 =
x 6.50 =
x 6.50 =
x 6.50 =
x 20.00 =
x 9.00 =
NOTE: MINIMUM PERMIT FEE IS $20.00
Signature
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 15.00
EQUALS: TOTAL PERMIT
FEE DUE
= $
Spokane County Department of Building and Safety
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