1990, 12-06 Permit App: 90006620 Furnace, Piping tethiviii iit°rt.'itarisito4g .al-ai
Information Worksheet
JOB STREET ADDRESS. ) f 74 4 h
CITY/STATE/ZIP:jj,/J4/OE /j%4. 792"7 PARCEL. NUMBER:
OWNER: \ 5PHONE NUMBER: jP�- _514,?.3'
MAILING ADDRESS:
(Street) / (City/State) (Zip)
CONTRACTOR: ah/&12P�i�,i d k LICENSE NUMBER: C�[�/I7Ei /S C.T
PHONE NUMBER: F 2Z-d C)C]
MAILING ADDRESS: E 1170.2._ VVl ie �J, (L i,4- Zo 4%
+ (Street) (City/State) (Zip)
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 =
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) X 4.00 =
GAS PIEING (5 OR MORE. EACH: ) x 1.00 = L q
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 $ l
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT^
NOTE: IMUM P •j FEE IS $35.,00 FEE DUE k = $ 38 k
SIGNATURE I OF� .
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (5009) 456-3675