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1991, 07-05 Permit App: 91004009 Furnace, Water Heater MECHANICAL PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: S .�- 8 / S w < (. ✓? CITY/ ATE/ZIP: /cam 9 2.-© a PARCEL NUMBER: -NER: 13 ( -- G L,4& PHONE NUMBER: ? 7 S. MAILING ADDRESS: _�7--' 7^5?2-e (Street) (City/State) (Zip) CONTRACTOR: 311'►•vo€L/L 1 A_.r LICENSE NUMBER: /3,41-14^/ CFC 37PN7' PHONE NUMBER: MAILING ADDRESS: O. 130 k 43 it 1 920 L. (Street) 4Qtate) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = WOODSTOVE/INSERT • x 25.00 = GAS WATER HEATER { x 10.00 = 0 0 GAS EQUIPMENT<100,000 E3TU (INCLUD S ' x 12.00 = /L.-esu GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 = GAS PIPII.'C (FA OUTLE1) x 1.00 = r3OILER/REFRIG 1-100M BTU x 12.00 = BOILER/REFRIG '101-500M TU'' 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 CONDITIONER 0-3 TONS x 12.00 = HE AT 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 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 = ULINSTED 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 NOTE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTAL PERMIT FEE DUE _ $ ?1/7 SIGNATURE Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675