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1990, 11-02 Permit App: 90005868 Furnace, Piping k MECHANICAL PERMIT APPLICATION FORM J_ Information Worksheet C-- i JOB STREET ADDRESS: t lJ 1 © ( L A, L -Y CITY/STATE/ZIP: `C ( ( PARCEL NUMBER: OWNER: K (,j,L r4ID t--k1at() PHONE NUMBER: ?2 q OV-V7 MAILING ADDRESS: 1= 0 l `J ‘ p.(,)/„61.A.0_ L & 9 21 (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (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 f x 12.00 = HEATING EQUIPMENT +100,000 BTU x 15.00 = GAS PIPING (EA OUTLET) 1 x 1.00 = 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 = EVAPORATIVECOOLERS 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 PERMIT NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE = $ SIGNATURE Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675