1994, 09-01 Permit App: 94008538 Furnace, AC - , 1-1581-1) 157) MECHANICAL PERMIT APPLICATION FORM •
:information Worksheet a`7 , g.S _OB STREET ADDRESS: S, // l,l ,ci). i ,rteC�
CITY/STATE ZIP:5 p4-1,/,‘,,,,,...,.Iv c( 7y.(1,7,4-PARCEL NUMBER:
OWNER: K TA .)1)1, 0 v ti t. -�,t,--,A PHONE NUMBER: 9�-/ 3//.�
MAIUNG ADDRESS:
, I (Street) (City/State) (ZIP)CONTRACTOR: A)D-r-c-oLiA.t--c r°1. LICENSE NUMBER:A)0 iEC 0 1/A 0 76, 4.
J / PHONE NUMBER: rj 3 �/ 'l 17
MAIUNG ADDRESS: J /o , I �.-4,... S' e- ,-,ate) /tin 9'9;5 j °�
` Y /. (Street) �ty/State) (Zip)
O 1 I �L MECHANICAL WORKSHEET/FEE SCHEDULE
L l V 15 NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
WOODSTOVEJINSERT,{: .....5.;: >` , x 25.00 =
GAS WATER HEATER x 10.00 =
GAS:EQUIPMENT<100,000 BTU(INCLUDES
/ x 12.00 in /0, on
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS'PIPING(EAOUTlE.:::'::'... x :. :: x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 in
BOILERIREFR{G 101; 500M BTU ..... > x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 -
BOILER/REFRIG:1,0001-1,750M BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HEAT PUMP•&AIR CONDITIONER0=3•TONS 1 x 12.00 = /�, C) O
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 in
HEAT PUMP&AIR CONDITIONER::15-30.TONS ... j x 25.00 no
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 in
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 IIHOOD x 10.00 = • -
CLOTHES DRYER x 10.00 =
:
....::' .,....:. ......::: ....:.; x 10.00 = ,
'RANGE
GAS LOG
x10.00 =
MISCELLANEOUS(NOT COVERED:ELSEWHERE.' x 1,0.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
:ULINSTED GAS APPLIANCE 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 a
:AIR_HANDLER>1;0,000 CFM x 15.00 =
SUBTOTAL $ y o 0
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE _$*/iOL,
SIGNATURE _ ,f ' J.- r
Spokane County Division of Buildings
West 131 'way Avenue Spokane, WA 99260 (509) 456-3675