1991, 09-30 Permit App: 91006348 Furnace, PipingMECHANICAL PERMIT Af;'PLfC/1TION FORM
Information Worksheet
JOB STREET ADDRESS: S°R.'37°S uaod,2aFP
CITY/STATE/ZIP:-r`5 f 0 kms, �h • 9`120(42 PARCEL NUMBER:
OWNER: dAtAS6 iii•A lri PHONE NUMBER: 92-2-49G(
MAILING ADDRESS: SAm'\E
(Street) (CitylState) (Zip)
CONTRACTOR: ti It( C-KAtoi.2Sj LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (CitylState)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
PrOcat
GAS EQUIPMENT +100,000 BTU DUCTWORK)
BOILER/REFRIG 1-100M BTU
BOILER/REFRIG §01-1,000M BTU
BOILER/REFRIG +1,750M BTU
UktPWAIR (3..1:N,. S e,„;. :a
HEAT PUMP & AIR CONDITIONER 3-15 TONS'
EA - ftlaggagO`,`"1 'hies +_,OQ
HEAT PUMPS &`AIR.CONDITIONER$0=50„TONS,
TYPE I HOOD (PER -12' OR 12' PTN: OF HOOD)•:
CLOTHES DRYER
GAS LOG
MISCELLgN 00107. 91141 D £LSEW:
UNLISTED GAS APPLIANCE <400,000 BTU
ULINATEO�`GAS APPL.IANCEgb000 BTU
USED APPLIANCE <400,000 BTU
AIR HANDLER <10,000 CFM
AIR HXNDLER>10 000„CFM 3 s
NOTE: MINIMUM PERMIT FEE IS $35.00
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x10.00 =
x12.00 =
r
x 15.00 =
x 1.00 =
1
x 12.00 =
x20.00=
x25.00 =
x 35.00 =
::.
`X 60.00 =
x 12.00 ='
.
x20.00=
x5.
2p0
""1-4..--) ..9- .Ln
HxW0.06
1
x 10.00 ._
S
x10.00=.,
x50.00'=
..
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 PEANUT
FEE DUE
= $
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675