1991, 02-04 Permit App: 91000349 Furnace, Piping 2 /
MECHANICAL PERMIT APPLICATION FORM
Informations Worksheet
JOB STREET ADDRESS: /1 I 5 ti'r 5 04 /`F.��� -
CITY/STATE/ZIP: v6 Y�G(,/AQ J (,tJ A . 9, (PARCEL NUMBER: A (/�.1� ' jam'
OWNER: Th0/7/(:`U'v '�/i,n_1_, 1 PHONE NUMBER: q�7 -0 J�/ii���
MAILING ADDRESS: I C> C' S u / 5 (7-,
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(Street) (City/State) (Zip)/
(7 7
CONTRACTOR: it, , 04C-01 �y`L� CGYl} LICENSE NUMBER:
PHONE NUMBER:
y� ,I�
MAILING ADDRESS: /v� / 3() Ji47�l �VG' --ail v") /,'c 9(0 0,
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM -x$10.00 =
WOODSTOITE/INSERT x 25.00 =
GAS WATER HEATER x 10.00 =
HEATING EQUIPMENT <100,000 BTU V x 12.00 =
HEATINGEQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING :(EA .OUTLET) V x 1.00 =
REFRIG1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00
REFRIG 101-500M BTU x 20.00 -=
REFRIG 501-1,000M BTU x 25.00 =
REFRIG 1,001-1,750M BTU
x 35.00
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 & 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 =
UNLISTED 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 $
PLUS: PROCESSING FEE + $ 25. 00
^
EQUALS: TOTAL PERMITi
NOTE: MINIMUM PE IT�F�EE IS $;5. 00 FEE DUE = $ i
SIGNATURE aj /kzi1 Q44 11 �
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675