1991, 07-05 Permit App: 91004002 Furnace, Piping MECHANICAL PERMIT APPLICATION FORM
` r Information Worksheet
J• ' STREET ADDRESS: N • 3 U I S TR /
•TATEIZIP: w-/ 2- PARCEL NUMBER: ie5/ 3 -- C//25
OWNER: len t Cc-�-- J �e%) S PHONE NUMBER: ;.? `/ s-0 9 Z
MAILING ADDRESS: -S/9-0-1/c
(Street) (City/State) (Zip)
CONTRACTOR: N4E'- i`^' C'43 LICENSE NUMBER: 6°15W/1/414 CF 17 dj"r
PHONE NUMBER: S3f /7 G7
MAILING ADDRESS: Pt j3 1, 3 Kc.. Sk2-°1-
(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 x 25.00 =
GAS WATER HEATER x 10.00 =
GAS EQUIPMENT<100,0001'3TU(INCLUDES x 12.00 = /Z a 0
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPIN(, EA OUTLET i 2'
x 1.00 = Z.a
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILER/REFRIG 101-500M-.BTU 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 Tn11S x 12.00
HEAT PUMP & AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP 8,AIR CONDITIONER 15-30 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP &AIR CONDITIONER+50 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 =
CLOTHES DRYER x 10.00 =
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>400,0008TU x100.00 =
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER>10,000 CFM •>I x 15.00 =
SUBTOTAL $ / Veal
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE _ $
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675