1993, 06-29 Permit App: 93005170 Furnace, Piping 6- 3 ,G MECHANICAL PERMIT APPLICATION FORM � /�O
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"""L l44 u 7, 4 )nformation Worksheet
JOB STREET ADDRESS: _ 44', -3 z/:,�,�' f7..t1�'1.,-/%7.- t
CITY/STATE/ZIP: . 1s`rrlk�.E- 1.. ,�t% j`jc.x06 PARCEL NUMBER:
OWNER: c -,-.._ PHONE NUMBER: ,�- �� ` ,�.�L-> ,
MAILING ADDRESS: j& -��. �S ov /` '
(Street) (City/State) (Zip)
CONTRACTOR: e k_ t ¢4Q7-rue - LICENSE NUMBER: /kai L il 1O8•5 J3
r PHONE NUMBER: X&,6)- c�
MAILING ADDRESS: - 1, '. I ( �J-LB-AI. � (2. t -, (A 1Z);?2c-,?_.?/9 /Si
(Street) (C y/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER I X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTQVE/INSERT- x 25.00 =
GAS WATER HEATER x 10.00 =
GAS:EQUIPMENT<100 000 BTU(INCLUDES / x 12.00 = /,•;1 , 06
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS:;.PIPING (EA OUTLET) / x 1.00 = /, d U
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REFRIG 101-500M ent:i: :<'`. ....... x 20.00 =
BOILER/REFRIG 501-1,000M BTU " 'x 25.00 =
BOILER/REFRIG`1,0001 1,750M BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP &AIR CONDITIONER 0-3 TONS x 12.00 =
HEAT PUMP & AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP & AI.R CONDITIONER 15-30 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAt PUMP &AIR CONDITIONER+5•0 TONS x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE COOLERS x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYPE II HOOD x 10.00 = I
CLOTHES DRYER x 10.00 =-
RANGE.- '.:':' ..:' - . . . '''':.. . .. . . .' . . . '
RANGE x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS (NOT 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 =
AIR HANDLER>10,000 CFM ,. x 15.00 =
SUBTOTAL $ 13, co
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTAL PERMIT
FEE DUE = $ 'A 0 v
SIGNATOR �n1�
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675