1994, 09-13 Permit App: 94008896 Furnace •
MECHANICAL PERMIT APPLICATION FORM Information Worksheet 1 il ✓ &cite_
JOB STREET ADDRESS: - ,) )1 Lc) t7 ta-t K A .
CITY/STATERIP:c
i(tinv ,/ /,e2q 77,r.)/% PARCEL NUMBER:
OWNER: IT)a.-y-i. n c; .A.4 2 .4 PHONE NUMBER: 'i " -
MAILING ADDRESS:
/ (Street) (City/State) PP)CONTRACTOR: A fr,? fp 0 LICENSE NUMBER:/t)(7 ye( j 11 1+ ,) 1
/ PHONE NUMBER:
MAILING ADDRESS: .� /O 1 - 1 El-y2,,,--/el„a / )0 97/3 /
(Street) (City/tate) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
.WOODSTOVE/INSERT h : w
..>.. ...... ... ..... . x 25.00 =
GAS WATER HEATER x 10.00 =
;GAS EQUIPMENT dOO,000BTU(INCLUDES x 12.00 =
GAS EQUIPMENT.100,000 BTU DUCTWORK) x 15.00 or
GAS PIPING(EAOUT x 1.00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
901 LA RIREFFMGE101-50OMBTU x 20.00 or
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOILERIREFRIG:,),000t4.Y;750M 8TU
x 35.00 =
BOILER/REFRIG +1,75•0M 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 =
EVAPORATIVE COOLERS x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 = a
TYPE II HOOD x 10.00 =
CLOTHES DRYER
RANGE x1 .00 =
..::> ....:.. ::� x 10.00 =
GAS LOG
x 10.00 =
MISCELLANEOUS(NOT COVERED'ELSEWHERE. x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU
x 50.1)0 =
;ULINSTED`GAS APPLIANCE>400,000 BTU: x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
USED•APPLIANCE>400,000.:STU x100.00 =
AIR HANDLER<10,000 CFM x 12.00 =
:AIR'HANDLER.>10,000 CFM x 15.00 =
SUBTOTAL $ 13, o 0
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =5 --, 7 j (F)
, --
SIGNATURE _� ,>, lfj)o---(f-
Spokane
-
Spokane County Division of Buildings
West 131 'way Avenue Spokane, WA 99260 (509) 456-3675