1989, 11-29 Permit App: 89004958 Furnace, Piping MECHANICAL PEWIT APPLICATION FORM
Information Worksheet ��11 S
JOB STREET ADDRESS: f\) 'Z`S\ q U ee. C q/& ) AVS
CITY/STATE/ZIP: PARCEL NUMBER: C157 = �lOZ
OWNER: C--)44"-.. O PHONE NUMBER: c> 2 C. 10,7
MAILING ADDRESS: 4 Sr 1.0 4,
,
(Street) (City/State) (Zip)
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CONTRACTOR: LICENSE NUMBER: PI It O 42
PHONE NUMBER: --'ST(Y-e-o
MAILING ADDRESS: E. 4y O'er, 6.
(Street)
(Ci y/State) (Zip)
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MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER x 10.00 =
HEATING EQUIPMENT <100,000 BTU („ x 12.00 = ( Ij,.o
HEATING EQUIPMENT +100,000 BTU x 15. 00 =
GAS PIPING (1 - 4 OUTLETS) x 4.00
GAS PIING (5 OR MORE. EACH: ) r \ x 1. 00 = l c
REFRIG 1-100M 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 $ 13 `&)
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT}
NOTE: MI MUM PE ' IT FEE IS 41635.00 FEE DUE _ $ S '-
SIGNATURE
Spokane County Denartment of Building and Safety