1991, 01-25 Permit App: 91000260 HeaterMECHANICAL PERMIT APPLICATION FORM
Inforaehtion Worksheet
JOB STREET ADDRESS: i J � I/, \AnJ pt [. J J)
CITY/STATE/ZIP: S g a n \A/14 PARCEL NUMBER:
F/0 r! 9 PHONE NUMBER: 9 .) - ?/?/.,/,MAILING ADDRESS: a I 2 ,N \' ilib/t Jai ;' d /' J/ 4V, )/14, 5-y-10,
(Street) -City/State) (Zip)
CONTRACTOR: S %<( y, Phi//))2y LICENSE NUMBER:
PHONE NUMBER:
OWNER: LD a y z
MAILING ADDRESS:
(Street)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UTNIT
DUCTWORK SYSTEM
WOODSTOW/INSERT
GAS WATER HEATER
HEATING:EQUIPMENT <100,000 BTU
HEATING -EQUIPMENT +100,000 BTU
.GAS PIPING .:(EA=; OUTLET]
REFRIG: '1-100M BTU(NOT A/C _ OR HEAT PUMP)
REFRIG 101-500M=BTU
REFRIG 501-1,000M."BTU
REFRIG 1,001 -1,750M -BTU
REFRIG +1,750M` -BTU.
HEAT PUMP:'&: -
HEAT PUMP &
HEAT PUMP -&
HEAT PUMP &
HEAT PUMP &
VENTILATING
'AIR:CONDITIONER 0-3 TONS _
AIR'CONDITIONER 3-15 TONS
AIR 'CONDITIONER 15-30 TONS
AIR CONDITIONER 30-50 TONS
AIR CONDITIONER +50 TONS _
FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)_
UNLISTED GAS APPLIANCE <400,000 BTU_ _
UNLISTED GAS APPLIANCE >400,000 BTU_ _
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <16,000 CFM
AIR HANDLER >10,000 CFM
1n t
= AMOUNT
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
NOTE: MINIMUM PERMIT FEE IS $35.00 = $
SIGNATURE IC E ,4Lg f ---
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 9 260 (509) 456-3675